Have Pro Fee Coding Questions? Find Solutions With These Examples
Have Pro Fee Coding Questions? Find Solutions With These Examples
ProFee, or professional fee, refers to coding and billing the physician side of a patient encounter. ProFee coding covers the work performed by the provider and the reimbursement they will receive for the medical services performed. To further understand the following Pro Fee (professional fee) coding examples and definitions, think: “ProFee is personal.”
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Examples of Pro Fee Coding
Utilizing Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) code sets, ProFee coders assign codes based on the amount of time and work performed for a patient (CMS, 2019). Coders find the correct CPT code, and per the Medicare Physician Fee Schedule, which CMS has mapped out (CMS, 2020), the providers will earn a set amount of points called Work Relative Value Units (RVUs).
For some medical groups, paychecks are calculated by total RVUs per month. At the end of each month, the RVUs are calculated, and a dollar amount is equated to the total number of RVU points. The provider is given a reimbursement check based on that total. In summary, ProFee coding directly impacts a provider’s paycheck (remember, ProFee is personal).
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Below are professional fee coding examples of how different codes for similar procedures can have major point differences in their RVUs. Because of this, it is crucial for the coder to make the correct code selection based on provider documentation:
Repercussions for Incorrect Code Assignments
Unlike facility coding, ProFee coding has a 1-for-1 code match for reimbursement, whereas facilities use reimbursement groups called APCs. There are similarities and differences between how facilities code and bill compared to how providers complete these steps. Please take a look at our previous article for more examples.
Since ProFee coding has a 1-for-1 match, there is little-to-no room for error. And, when there is an error or discrepancy in the coding, the providers eat the costs. Here are some tips to eliminate those risks for inaccurate profee coding.
In addition, communication is necessary for accurate and complete ProFee coding. This allows providers to consult with coders on their selections. Discussions and questions centered around ProFee coding with physicians will happen, so refer to our article, “Top 5 Tips to Resolve Profee Physician Discrepancies,” on how to better communicate with providers on these questions.
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