Coding, Classification and Reimbursement

E&M Office codes vs Hospital out patient visits

  • 1.  E&M Office codes vs Hospital out patient visits

    Posted 09-23-2014 14:54
    When are you able to use a physician office E&M code in a outpatient hospital visit?

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    Sarah Stewart
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  • 2.  RE: E&M Office codes vs Hospital out patient visits

    Posted 12-04-2014 22:43
    Sarah, I code Hospital Outpatient Clinic (HOC) visits.  We use the same E&M codes that you would use in an office setting (99211-99215, 99201-99205) for the professional fee for the physician and for the facility fee.  However, for Medicare patients, we must now use G0463 for the E&M facility fee. (See page 3 of the MLN document in my link below).

    http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8572.pdf

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    Melissa Bugay CPC, CPC-H
    Hospital Outpatient Coder
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  • 3.  RE: E&M Office codes vs Hospital out patient visits

    Posted 15 days ago
    Hi Melissa,
    i have a follow-up question for you. I'm auditing physician charges where the doc bills for their service with 99201-99215 on a CMS 1500 and the hospital bills with G0463 on a UB for the clinic. My doc is giving injections (96372) and blood glucose labs (82962) during the E/M service, but not billing for these on the CMS1500. Are the injection and lab codes billed on the UB with G0463, or does the doc bill them with the E/M service on the CMS1500 claim?

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    Jenny Harvey, RHIT, CPHQ, CPMA, CPC
    Manager, Healthcare Consulting
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