Facility Coding
The Coding Network is a trusted provider of precise and compliant coding services for a wide range of healthcare facilities—including hospital outpatient departments, clinics, ambulatory surgical centers, emergency departments, cardiac catheterization labs, and diagnostic as well as interventional radiology departments. Whether you're facing a temporary coding backlog or seeking efficient, high-quality coverage for part or all of your coding needs—short-term or long-term—we offer flexible solutions designed to improve accuracy, reduce costs, and support your operational goals.
Facility coding important?
In outpatient facility settings, it's important to understand that both the facility and the healthcare provider can submit separate claims for services rendered. While facility coders focus on capturing the technical components related to the use of space, equipment, and staff, professional fee (pro-fee) coders handle the billing for the physician’s or provider’s services. For example, if a specialist such as a cardiologist or gastroenterologist evaluates a patient in the emergency department, the facility will bill for the use of the ED and resources, while the specialist will separately bill using the appropriate evaluation and management (E/M) or consultation CPT® codes, such as 99241–99245. However, it's important to note that Medicare no longer accepts consultation codes, so providers and coders must follow the billing guidelines of each specific payer to ensure accurate and compliant reimbursement.
Physician Coding in a Facility Setting
Physician billing applies to both outpatient and inpatient settings. While many physician services occur in outpatient locations—such as offices, emergency departments, or diagnostic centers—physicians are not limited to billing only from these settings. Many have hospital admitting privileges and can bill for inpatient services as well.
During a hospital stay, the admitting physician typically visits the patient daily, performing and billing for inpatient E/M services using the appropriate CPT® codes. These codes capture the physician’s professional work, also known as the pro-fee.
In contrast, facility coders bill separately for hospital resources like room charges, nursing staff, medications, and supplies. These services are submitted using the UB-04 claim form (or its electronic version, the 837I Institutional claim), distinct from the physician’s professional billing.
A physician is a medical professional who diagnoses and treats illnesses, provides routine care, and helps patients stay healthy. They are essential to maintaining individual and community health.
Facility coding involves assigning codes for hospital or clinic services like procedures, equipment, and room charges. It ensures accurate billing and reimbursement for the healthcare facility.
Facility coding involves assigning codes for hospital or clinic services like procedures, equipment, and room charges. It ensures accurate billing and reimbursement for the healthcare facility.
An ambulance is a specially equipped vehicle used to transport sick or injured individuals to medical facilities. It provides emergency care on the way, often staffed by paramedics or EMTs.
HCC Risk Adjustment Coding uses diagnosis codes to estimate a patient’s future healthcare costs. It assigns a Risk Adjustment Factor (RAF) score based on medical conditions and demographics, helping ensure accurate reimbursement in value-based care models.
HCC Risk Adjustment Coding uses ICD-10-CM codes to capture a patient’s health conditions and calculate a Risk Adjustment Factor (RAF) score. This score helps determine reimbursement in value-based care by reflecting patient complexity
