Can we bill an E/M service with a scheduled endoscopy?

Question:

Can we charge an E/M service when we do a scheduled endoscopy to account for the cost of nursing staff, supplies, pre- and post- care of the patient in the suite? We use place of service office, and I know we can’t charge a facility fee. Many of our commercial payers pay the same professional fee, whether we do the service in our office or in the outpatient department.

Answer:

You cannot charge a separate E/M for doing a procedure in your office to cover the costs of the supplies, staffing, etc.

For Medicare, professional fees for CPT^® codes are valued with facility and non-facility values. The non-facility payment is higher than the facility fee. A physician gets paid more for a service done in the office than for the same CPT^® code/service done in a facility, to account for the additional costs. I’m sorry to hear your private payers don’t provide a differential payment, as well.

Here is a brief explanation of facility versus non-facility payments. This article provides a little more detail about RVUs.

And, if you search for modifier 25 in the search box, you will find resources about the requirements for that modifier.

 

Back to Everyday Coding Q&A

 

---

CPT is a registered trademark of the American Medical Association Copyright 2019, American Medical Association All rights reserved.