Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

outpatient coding

Loredana Posted Fri 20th of April, 2012 20:53:03 PM

Hello, our clinic is a hospital based and we need to start billing for facility as well and I do not have any experience on that, any advise would be appreciated.

SuperCoder Answered Fri 20th of April, 2012 20:58:05 PM

Outpatient coding guidelines
Outpatient coding guidelines differ from inpatient coding guidelines and has been listed below.

1. The primary diagnosis should be the condition which is the principle cause of patient visit established after study.
2. Differential diagnosis stated by the physician in the final impression should not coded instead symptoms must be coded. For example physician may state UTI/diverticulitis in the final impression, which should not be coded instead symptoms like abdominal pain should be coded as final diagnosis.
3. Laboratory and radiology findings interpreted by the physician can be coded as diagnosis in outpatient coding.
4. Acute state of a disease should be coded before chronic state if both exists. For example if the final diagnosis is acute and chronic bronchitis, acute bronchitis should be coded first and than chronic bronchitis.
5. Conditions stated by the physician by words "likely", "possible", "Rule out" are not coded in outpatient coding and instead symptoms need to be coded.

Loredana Posted Mon 23rd of April, 2012 17:35:05 PM

Thank you for your reply, but I was looking for cpt guidelines as how to bill for an office visit for example. We send, let's say, 99213 with a modifier, for facility? OOPS allows payment for facility for outpatient visits, my confusion is how to send it to the insurance company...I am ok with DXs.
Thank you.

SuperCoder Answered Tue 24th of April, 2012 09:06:51 AM

Office / OutPt. visits are still coded with 99201-99205 for new Pt.'s and 99211-99215 for Est. Pt.'s.

Modifier need not be used with E/M codes to show that the service was performed in OutPt. Set-up.

Since your clinic is hospital based, you will look for codes to be used with OutPt. setup, not any Inpt. code(s). For consultation cases, if your carrier accepts Consult codes, then use 99241-99245. See E/M section for OutPt. coding guideliens.

Loredana Posted Tue 24th of April, 2012 17:24:46 PM

how do you send the claims out for facility when you have an office visit? I know it needs to go on UB40 form, but do we need a separate tax id/npi, we need a modifier?....

SuperCoder Answered Wed 25th of April, 2012 08:25:10 AM

No, POS (Place Of Service) no. is important here... for outPt. hosp., POS is 22. se the list of POS nos. in front of CPT book. This will help you to specify about the location of the service rendered. You might also require to put the "type of bill" code and "revenue code", as per payer specification and requirement of UB-04 form.

Related Topics