Coding for the Outpatient Hospital Setting. Webinar Subscription Access Expires December 31.

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1 Coding for the Outpatient Hospital Setting Questions Answers Webinar Subscription Access Expires December 31. How long can I access the on demand version? You will find that in the same instructions box you utilized to access this presentation. Subscription access expires December 31, individual purchases will not expire for at least two years. If you are the purchaser, you can find your information through following these steps: 1. Go to & login 2. Go to Purchases/Items 3. Click on Webinars tab 4. Click on Details next to the webinar 5. Find the instructions box in the middle of the page. Click on the link to the item you need (Presentation, MP3 file, Certificate, Quiz) Where can I ask questions after the webinar? The online member forums, where over 100,000 AAPC members have access to help each other with all types of questions. *Forum Posting Instructions* 1.Login to your online account 2.In the middle of the page you will see discussion forums 3.Click on view all top right hand side 4.Select general discussion under medical coding unless you see a topic that suits you more 5.On the top left side of the forum box, you will see a blue button, new thread click on that 6.Type your question and submit 7.Check back in that location for answers as you please

2 Patient comes to ED, receives triage and initial assessment by RN. Patient leaves without seeing physician. Can we bill lowest ED level for facility charge? Is there a time limit on submitting additional charges to the insurance companies or is it based on the individual health plan? What is Medicare's rules for the question above, when the patient only receives a triage and initial assessment by an RN. Cam the lowest ED level for the facility be coded? Please define admit type 2, does the diagnosis, HCPCS, or Rev code (0456/0516) determine the type 2 admit code or is it based off of the status of the patient when entering the facility? If the facility is charging for physician services for a doctor employed by the hospital would ICD codes be used instead of CPT codes? Is observation always considered outpatient? I thought that all facilites must capture the icd or DRGs?? Rules may vary by facility or even by payer. I recommend that you refer to payer guidelines. Many facilities that I work with do not charge if there is only initial triage. Please refer to the individual payer's guidelines for claims submission deadlines. Please refer to your local Medicare carrier's guidance This is not a topic covered in the presentation. CPT and HCPCS codes are used in both Outpatient Professional Services coding (i.e. physician) and Outpatient Facility Services (i.e. hospital portion). Some facilities capture ICD9 procedure codes (Volume 3) for hospital outpatient in addition to the CPT or HCPCS code. Yes. By CPT definition, observation accounts are outpatient services. DRG'S/MS-DRG'S are for inpatient services. Today's presentation covers hospital outpatient services.

3 I thought that Vol. 3 was for inpatient services? That is something that is commonly stated. However, it is not completely correct. Many hospital's dually assign ICD- 9 px codes and CPT or HCPCS cods for procedures. Not all facilities use ICD-9 procedures though. Yes I understand that but in speaking about facility charges - you mentioend that "some" facilites have to apphend the icd-9... I thought that emergency room is considered outpatient, and that when coding for procedures performed by doctors working for the hospital, ICD codes are used. But are the ICD9 procedure codes used for billing, or are they used for data collection in the outpatient environment? Many hospital facilities use ICD-9 procedure codes in addition to CPT/HCPCS codes to report procedural services ED is an outpatient service. ED coding utilizes ICD-9 codes for diagnosis coding. It utilizes CPT and/or HCPCS codes for procedures, as appropriate. In addition to the above, many hospitals dually assign ICD-9 procedure codes from Volume 3 for procedures. It is a common misconception that only inpatient coders assign ICD9 procedure code. I can not speak for all carriers and all states since rules may vary. However, most facilities I work with capture the ICD- 9 procedure codes for data collection. Are E+M coding always used for OP settings? This presentation only covers hospital outpatient coding. Not all hospital outpatient visits will require or support an E/M code.

4 Why is the provider not able to charge a for supervision at an outpatient clinic when the patient is only seeing the nurse? Why is outpatient surgery not being addressed? POS 22 outpatient clinic - Patient seen by the nurse twice a week for cleaning of wound per MDs orders. Provider is in the office during the visit but not in the exam room, can the MD bill a on the Professional side and the nurse will bill the appropriate E&M on the facility side. Why is the provider not able to charge a for supervision at an outpatient clinic when the patient is only seeing the nurse? ANSWER: Please provide detail as to the exact circumstance you are referring to. The response could vary depending upon the documentation and other circumstances. Oupatient Surgery coding was not the focus of the presentation due to time constraints. We covering coding for the facility during this presentation. The exact E/M level reported would be based on that facility's internal guidelines. Hello, if a patient comes in each Monday for a month for a PT/INR, would it be appropriate to add the -91 modifier if the account is a series account and is only billed one time for the month? This presentation includes POS22 facilities, too, right? Would you put a modifier on the repeat venipuncture? Modifier -91 is used when the repeat lab is done on the same calendar date. If the services take place on different calendar dates, modifier -91 would not be needed according to CPT Guidelines. However, if you have specific payer guidelines to the contrart, I would refer you to those. If the payer accepts it then we would typically report 36415,

5 The information provided on page 55 is not consistent with "Coding with Modifiers". That book advises to use 91 because the code is included in the original panel. What source are you referencing? I do not have the book Coding with Modifiers. I am referencing CPT Assistant, June 2002, pgs 1-3. The examples show that mod -91 was used when a test with the same CPT code was repeated. In addition, CPT Asst Sept 2003, pgs 5-7. "As indicated in the descriptor language for use of modifier '91' it is used to identify repeat performance of the same laboratory test on the same day to obtain subsequent (multiple) test results. For example, if a second culture was performed of the same wound site on the same day, then modifier '91' would be appended." Since these were in fact two different procedures (one a panel and the other an individual test) modifier -91 does not appear to be the most appropriate based on the modifier descriptions and information in CPT Assistant. However, payer guidance may be different. I would refer you to individual payer guidelines if the example provided is not consistent with the directions received at your facility. i can say as a payer -- we would only issue payment for one we were under the impression that can only be billed once per day. do you have supporting research available to share for the statement of '36415x2'? Thanks! Thank you for responding. Many times there is a difference in coding and billing. This is why I thought it very important to mention that when dealing with code In the recording, I mentioned that many payers will only accept 1 venipuncture code per day. I recommend that you refer to your payer policy

6 Most our labs are drawn and sent out, we only bill for the venipuncture and specimen handling.. Would we still use units of 2,3,4..ect. if more than one lab was done? Venipuncture code 36415, is typically accepted only once per calendar date. I recommend that you check your payer policy. However, if the payer accepts more than on venipuncture per date, it would not be assigned based on the number of labs done. It would be based on the number of actual draws. But again, I caution you. Most times the payer will only accept one per calendar date. Can Modifier 27 be used on a second E/M service same date if seeing two different specialties on the same date? it is very important that documentation is there; otherwise a payor will deny is modifier 27 specific to only outpatient facility coding? if an ED physician orders an ultrasound, then both professional and facility charges would be billed out? Or does it depend on how the charge code was set up? In the facility setting, if providers from different clinic(s) or settings see the patient on the same date, then yes. Modifier -27 would be appended to the second E/M code. Agreed. If it wasn't documented, it wasn't done. Modifier -27 is used in reporting both physician/professional and facility services This presentation covers the facility coding only. Many factors may come in to play here. However, the facility would need to capture the facility portion of the ultrasound that was done by reporting the appropriate CPT/HCPCS code.