Author Topic: E & M codes for an outpatient hospital visit  (Read 1877 times)

jammer

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E & M codes for an outpatient hospital visit
« on: August 18, 2015, 09:36:14 PM »
Need help..... we have a payer that will not pay an E & M code if it is billed on a UB.  They say it has to be on a 1500, however it is an outpatient hospital visit and shouldn't be billed on a 1500.  They say it is their policy.  How can a payer tell me how to bill to get paid when it is wrong.  What can I do?

Merry

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Re: E & M codes for an outpatient hospital visit
« Reply #1 on: August 18, 2015, 09:38:32 PM »
You need to follow carrier policy. What kind of out patient facility?

jammer

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Re: E & M codes for an outpatient hospital visit
« Reply #2 on: August 18, 2015, 09:43:05 PM »
Thank you for your quick response.  Hospital.  There has to something that can be done.  They are avoiding payment of services.  All the other payers will pay it.  It is so frustrating.

RichardP

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Re: E & M codes for an outpatient hospital visit
« Reply #3 on: August 19, 2015, 03:04:39 AM »
Are you billing for the Hospital?  Or are you billing for a provider who saw the patient at the hospital?  Our providers see their patients at the Hospital - either as outpatient or inpatient.  In either case, we bill using the CMS 1500 Form and get paid.

PMRNC

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Re: E & M codes for an outpatient hospital visit
« Reply #4 on: August 19, 2015, 07:13:03 PM »
I think people missed this:

Quote
we have a payer that will not pay an E & M code if it is billed on a UB.

The carrier is correct.. the E&M should be billed on a CMS-1500, it is a professional service. Only facility billing goes on UB!
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

jammer

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Re: E & M codes for an outpatient hospital visit
« Reply #5 on: August 19, 2015, 08:36:24 PM »
Our billing software says it can be billed on a UB.  I am so confused! :'(

PMRNC

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Re: E & M codes for an outpatient hospital visit
« Reply #6 on: August 19, 2015, 10:59:48 PM »
Don't rely on your billing program because again.. E&M codes are professional codes..they need to go on CMS-1500.... period. Facility billing is the UB
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

aa1098

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Re: E & M codes for an outpatient hospital visit
« Reply #7 on: August 21, 2015, 04:18:28 PM »
I know of a facility that bills E/M codes on a UB for the facility fee and also bills the profee as an E/M code on CMS-1500.

A quick google search found the following which discuss facilities billing E/M codes (of course, G-codes must be used for billing Medicare for facility clinic visits). http://www.hbma.org/news/public-news/n_e-m-physician-versus-facility