Health Information Management

Q/A: Billing for technical component of clinic visit

APCs Insider, March 5, 2010

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Q: My hospital has multi-specialty, provider-based clinics, so when billing for clinic visits, we split them into professional and technical components. May we bill the technical component for a visit that is covered under the global period? For example, we excise a patient’s wound and schedule a follow-up visit to check the wound. We wouldn’t bill the professional component, but may we bill the technical component to cover use of our facility and resources?
A: The OPPS payment system does not include a global period (i.e. a period of time after a procedure during which care related to the procedure is included in the original procedure performed). 
This is a feature of the physician payment system, and appropriate relative values are set to include this care. However, this additional care is not a part of the OPPS rate-setting methodology. Therefore, if a hospital schedules visits following a procedure, those visits are separate from the original procedure, regardless of how the professional portion of the visit is paid (i.e. as part of the global period for the physician in this case). Hospitals should bill for those visits as they would for any other patient visit. Bill the appropriate CPT code for procedures denoted by CPT codes. If no CPT code describes services rendered, assign the appropriate E/M visit code. Follow your hospital visit guidelines to determine which E/M level you should bill for the technical component.
Assign a visit code in addition to a procedure for the encounter only if there was significant, separately identifiable work beyond the usual preoperative and postoperative care for the procedure performed during the same visit.

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