Provider based billing

Hi Pam,

I got your email address from the AAPC forums. I hope you don't mind me emailing, but I need some clarification and saw that you were knowledgable regarding provider based billing.

I am coding for an urgent care facility that is owned by the hospital. It has recently gone to provider based billing. However we are only coding provider based for Medicare currently and we are only charging the G0463 code on the facility side with everything else being billed on the provider side. I have been researching this and it seems that we should be charging more on the facility side. A patient will come in and receive multiple injection or intravenous drugs and we are not getting reimbursed for any of it. We are only able to recoup the money for the E&M charge and any procedures.

My specific questions are these:
1. Instead of billing (for example) a 96372 on the provider side, would I bill that to the facility side?
And if so, does the G code receive a 25 modifier like a 99211-99215 would?

2. When a procedure is completed, i.e. 12001, do I bill this on the facility and the physician sides?
And if so, would I use the 25 modifier on each E&M code?

3. Do I code an E&M code on both the facility and provider sides?

Any information in this area would be extremely helpful!
Also any documentation regarding this with examples would be greatly appreciated!

Thanks in advance for any advice!

Provider based billing