Despite the vast number of charts and tables dedicated to determining the perfect code for a patient visit, instances of multiple codes can still cause discrepancies and confuse coders who aren’t careful. Chief among these is the difference between physician codes and facility codes. When a patient visits a hospital, it is likely that the facility will use multiple codes to convey information to different groups.
When a new patient visits a private practice, the coding is relatively straightforward. In this case, the physician will record either 99221, 99222, or 99223 depending on the level of care needed. These codes contain all the necessary information for first-time patients, as well as the corresponding levels or reimbursement.
Issues can arise, however, when the physician is operating out of a hospital or other large facility. In these cases, the facility will code separately from the physician, meaning that the patient will receive additional charges. Though patients typically get a single bill, both medical entities have their own codes that they keep track of individually.
In this case, major facilities use the code G0463. Unlike physicians’ individual codes, G0463 is a general designation used by hospitals. This code applies to virtually all patients, as it does not differentiate between initial and subsequent visits. It also require no specification as to the level of service; it simply indicates that the patient received medical attention from the facility, regardless of the scope of treatment.
Due to the nonspecific nature of the G0463 code, the individual physician who is acting on behalf of the facility will still need his or her notes coded using the traditional five-digit format. Without this additional documentation, there is no support for the hospital’s billing, which in turn allows patients and auditors to contest the charges.
In short, major facilities often use the general G0463 code to account for overhead expenses, oftentimes at a flat rate. On top of this, the coders working for individual physician will need to use traditional E&M coding to catalogue the patient’s specific issues and proposed treatments. Though it may seem confusing at first glance, these two sets of codes actually go hand-in-hand. Together, they provide all the necessary information to ensure the patient receives a correct and complete billing statement.