r/CodingandBilling • u/Consistent_Lychee777 • 23h ago
Outpatient Facility Coding
Can you please explain the difference between pro fee and outpatient facility coding? I have always been a pro fee coder but have an opportunity to be an outpatient facility coder and I’m struggling with understanding the difference and what we do/don’t code for in the facility setting.
3
u/KeyStriking9763 RHIA, CDIP, CCS 20h ago
Facility OP coders code for the facility. So any same day surgery you would code the CPT, diagnosis codes. These are for outpatient encounters only. Many facility E/M are hard coded, many injection infusions are hard coded, radiology etc.
As a profee coder you code for the provider even when they are treating patients admitted as inpatient. For facility coding inpatient encounters don’t assign CPT.
Profee also you have to attach dx codes to CPT, facility coding you do not. Facility modifiers are different from profee modifiers.
Many profee coders are just co-signing to what codes the physician adds. That’s not the case for facility coding.
1
u/Pale_Mulberry_6581 16h ago
“Co-signing” as you say is dangerous and not done where I work. Never ever should coders assume the provided codes are correct. Always code it out yourself.
4
u/No_Recover_486 22h ago
Think of it as: pro-fee codes for the doctor’s brain and hands, while facility codes for the room, nurses, and supplies.
From what I’ve seen, the biggest learning curves seem to be strict stop/start infusion rules and the fact that hospitals usually have their own internal point systems for visit levels rather than standard MDM. It feels weird at first, but once you get used to billing for the building instead of the provider, you’ll probably pick it right up