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Melissa Posted 1 Year(s) ago
Our physician is contracted by a hospital to provider pain management services in their Out Patient Pain Clinic. We bill only the professional fees. Usually our Physician or PA performs the pump reprogram, analysis and refill and we bill 62370 for that service . Now, the RN's that are employed by the hospital are going to be performing that service ( 62369 ) at the direction of the physician. Am I correct in assuming that only the hospital will be able to bill for the 62369 and the physician or PA can only bill for an office visit if applicable? They want to bill for both since they are directing the RN. Thank you
SuperCoder Posted 1 Year(s) ago

Hi,

You should not bill office visit by the physician if the nurse refill the pump. In order to bill an office visit in addition to pump refill and/or reprogramming. A significant, separatley identifiable E/M service that would go above and beyond the pre and post work of doing a pump refill would have to be performed and modifier 25 would be added to office visit in that situation. But if the physician is seeing the patient and instructing the nurse to refill the pump with a certain dosage setting than you bill 62369 under the physician's NPI. The facility fee would be the same code 62369 under the facility NPI. 

Hope that helps!

Melissa Posted 1 Year(s) ago
thank you!
SuperCoder Posted 1 Year(s) ago

Your welcome!

Melissa Posted 2 month(s) ago
do I need to append modifier 26 to the physician claim?
SuperCoder Posted 2 month(s) ago

No, not required.

Posted by Melissa, 1 Year(s). There are 6 posts. The latest reply is from SuperCoder.

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