Author Topic: Dr is on call for hospital, how to bill?  (Read 1436 times)


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Dr is on call for hospital, how to bill?
« on: November 07, 2013, 02:04:07 PM »
Hello! One of our dr's is the ophthalmologist on call for the week for some of the local hospitals. I have only ever billed for her work in the private practice. So I have three questions:

1. How do I code the visit when she see's the patients in the hospital? Or is this something the hospital bills? Just change the place of service?  What if we are not contracted with the patient's insurance?

2. Those patients she saw in the hospital are also coming for follow ups in our office, how do I bill those visits to show it was an ER follow up?

3. New patients are calling the hospital with eye problems and the hospital is referring them to our dr since she is on call. How do I bill those insurances that we are not contracted with (is there a modifier that says it was an ER and she was on call)?

Thank you!


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Re: Dr is on call for hospital, how to bill?
« Reply #1 on: November 07, 2013, 02:42:34 PM »
There are not simple answers to your questions.  So I'm going to get you started, and others can join in.  First off, let's establish some theory.

Forget the questions you have posted for the moment, and just consider these two questions:

Someone comes in to the office with a bad cut on their hand from broken glass.  Is it likely that the doctor could sew the cut shut in the office?  Someone else comes into the office with a bad case of appendicitis.  Is it likely that the doctor could perform an apendectomy in his office?  (Office, not surgical center.)

In general, there are codes for procedures that can be performed in the doctor's office.  There are other codes for procedures that the doctor must perform in a more formal setting, such as a surgical center or a hospital.  These codes are for billing the procedures that the doctor did.  The hospital has its own sets of codes for what the hospital staff might have also done in support of the patient.  The post at this link is sort of a heavy slog - but if you skim through it you might find some of the information useful re. the separation of codes for what doctors do in a hospital setting vs. codes that the hospital uses for its staff and overhead.

The fee slip for our clients' use has a section for codes pertaining to Hospital Consults and Visits.  A separate section has codes for Office Consult.  Separate sections have codes for Established Patient Visit and New Patient Visit.  Then there are other sections for Procedures performed.  Those procedures performed mainly in a Surgical Center or hospital are grouped separately from those procedures that would be performed in the office.

Note that at least Medicare distinguishes between inpatient (patient admitted to hospital) and outpatient (patient not admitted to hospital) procedures.  If inpatient, Box 18 on the CMS 1500 Form must contain at least the date the patient was admitted (not the date the doctor performed the procedure).

If the hospital refers patients to you, and they are first seen in your office, that would be billed as a new patient visit.  The fact that they were referred to you is relevant to your billing only if it is relevant to the patient's insurance carrier.

I'm sure this site has some materials available that will give you a more detailed overview of all that is involved in billing for procedures done in the hospital.  But, for starters, you might take a particular patient and tell us what procedures were done.  If you are just billing, and not also coding, for your clients - you should have received something from the doctor that tells you what level of complexity the hospital visit/consult was, along with the diagnosis and procedure codes.