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Melissa Posted Wed 11th of October, 2017 17:03:01 PM
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 Answered Thu 12th of October, 2017 05:22:05 AM


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 Thu 12th of October, 2017 09:53:23 AM
thank you!
SuperCoder Answered Fri 13th of October, 2017 00:18:43 AM

Your welcome!

Melissa Posted Wed 28th of February, 2018 12:03:35 PM
do I need to append modifier 26 to the physician claim?
SuperCoder Answered Thu 01st of March, 2018 06:25:29 AM

No, not required.

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