Blog

Seeing Outpatients at Hospital - How Do I Bill?

Q. I have a private practice and have privileges at a local hospital. Sometimes I schedule follow-up outpatient visits for my and the patient's convenience at the hospital, if they live closer to the hospital than my office. The space I use is in the ER, but the patients do not register with the ER. What place of service should I use for billing?

The below answer is provided by Louis Burke of E Central Management, a billing and management company that works with medical practices with code changes, patient billing and follow-up, and immediate appeals on underpaid or denied claims.

A. This is a tough one. The appropriate answer is that if you physically see a patient in the ER, even for outpatient services, you should be billing a code 23 for the emergency department location. When seeing a patient in an outpatient setting, i.e. hyperbaric unit, use place of service code 22. Unfortunately, my experience has been that when using a hospital site of service code for outpatient, you may receive a denial, as the carrier will want to deny an office visit E/M code being used with an outpatient place of service code. However, if you do receive a denial you should definitely appeal. If appealed in the right way you should get paid. In sum, my suggestion is to have the patients come to the office whenever possible and if not possible write a note in the claim detail area describing the situation at hand.

If you have a billing question please feel free to contact Loius directly at (917) 838-9510 or Louisb@ecmmgt.com. Louis will be addressing topical questions on a regular basis on this listserv as well for the benefit of the group, so also feel free to email any questions of a billing or coding nature and I will be sure to pass it along.

For additional information on this topic, please contact Jennifer Kirschenbaum at (516) 747-6700 ext. 208 or at Jennifer@Kirschenbaumesq.com. This email is for education and discussion purposes only and does not constitute legal advice. To access prior healthcare email newsletters or articles visit: www.kirschenbaumesq.com/healthcarearticles.htm.

E Central Medical Management, Inc.

2050 Lakeville Road,

New Hyde Park, NY 11040

Phone. 516-775-8606

Email. info@ecmmgt.com