Coding > Coding
E & M codes for an outpatient hospital visit
jammer:
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:
You need to follow carrier policy. What kind of out patient facility?
jammer:
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:
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:
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.
--- End quote ---
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!
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