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Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

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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.

 

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Last revised June 28, 2021 - Betsy Nicoletti
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Wondering about the rules for HCC coding?

Wondering what the rules are for HCC coding, and where you can find them? This video answers your questions. The topic is important to medical practices because risk-adjusted diagnosis coding is part of Medicare Advantage contracts, many commercial contracts and Accountable Care Organizations (ACOs). Sign up for our monthly newsletter to download the whitepaper and watch the video.

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Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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