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Report revenue code based on setting

APCs Weekly Monitor, November 12, 2004

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Report revenue code based on setting

Q: We are a hospital that frequently provides outpatient services such as injections and infusions. Occasionally, a patient comes in for a scheduled injection but has his or her own medications. Is it appropriate to charge for this using a 510 revenue code and a low level E/M code such as 99211, or can we send the claim in with only the injection charge (90784)? Is there another way to handle these claims?
 
A: First, you need to establish that you have a physician order associated with the outpatient service. Then you must determine the place of service before you can assign a revenue code.

If a provider performs the service in a treatment room within the facility, use revenue code 761. If a provider performs the service in a hospital-based clinic setting, use revenue code 510. If a provider performs the service in a minor surgical room setting, use revenue code 361. Once you establish the appropriate revenue code, you can then determine the appropriate CPT/HCPCS code.

If the patient presents only for a procedure or treatment (i.e., injection procedures in this case) associated with an identifiable CPT/HCPCS code (i.e., 90782, 90784), you can only bill the procedure/treatment code. An additional E/M charge code is not appropriate.

An E/M charge code, along with the procedure charge, is appropriate only if you have documentation to support a significant separate E/M service above and beyond the procedure (such as another condition unrelated to the injection being evaluated). The documentation must reflect the history, physical, and medical decision making to support the significant separate E/M service performed.

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