Place of Service

[tfischer]

Our office keeps getting denials for invalid place of service of 22 with therapeutic injections 96372.

Does any one have any suggestions?

Thank you,

[cyndeew]

96372 is the stick and 22 is for outpatient. Since you said "our office..." I'm guessing that you're doing this in your office, and in that case, 11 is the POS code.

[tfischer]

But the office is considered an "outpatient clinic" that is why the office is always billed with 22 POS. I guess we don't understand why this place of service is being denied with these injections, and no other charges.

Thanks!

[cmcgarry]

So - are you "provider based"? In other words, does the hospital bill a clinic charge, etc., on a UB04 claim? If you are not considered an outpatient department of the hospital, you should be billing with POS 11 for office, even if located on a hospital campus. If you are billing with POS 22, reimbursement for your services is based on facility, not non-facility Medicare fee schedule. In addition, any diagnostic tests would have to be for interpretation only, or they will deny. The 96372 can't be billed by a physician/NPP in a facility setting, as the facility should charge for it (we do have some clinics that are provider-based). If you give an injection into a joint (20600-20610) for instance; you charge the professional portion, the hospital charges a fee, and the hospital charges for the drug that was injected (Kenalog, etc.)

If you are not an OP department of the hospital you should use POS 11.

I hope this helps.