Place of Service Coding

Place of Service Coding

by John Verhovshek, MA, CPC

Place of Service Codes (POS) are two-digit codes reported on health care professional claims to indicate the setting in which a service was provided. Each billable line item should have a Place of Service Code listed to identify where the service was rendered. POS codes are listed in the front of the CPT® codebook, and are also available on the CMS website.

Certified Inpatient Coder CIC

Improper application of POS codes can affect payments. As CMS Transmittal 2679 explains, “Under the Medicare Physician Fee schedule (MPFS), some procedures have separate rates for physicians’ services when provided in facility and nonfacility settings.” For this reason, POS errors have been a recurring area of interest in the Office of Inspector General’s (OIG’s) yearly Work Plans.

Per Transmittal 2679, the POS code generally “reflects the actual place where the beneficiary receives the face-to-face service and determines whether the facility or nonfacility payment rate is paid.” Sometimes, more information may need to be obtained by a facility before applying a POS Code for an encounter. For example, a coder initially may believe that a facility is a nursing home, when it actually may be categorized as a skilled nursing facility or an intermediate care facility.

Finally, note that he POS code assigned for the professional component of a diagnostic service must match the setting in which the beneficiary received the technical component of the service (even if, in actuality, the professional component was provided in a different setting).

dec-clearance-sale

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 406 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

One Response to “Place of Service Coding”

  1. Janice Stead says:

    Hi John,
    I’m so glad I happened on this article, I’m confused about facility and nonfacility. An insurance co. wants money back because they say claim incorrectly paid at non-facility rate, this procedure was done in an out patient hospital facility, POS 22. Am I wrong in thinking they are incorrectly taking money back?
    Thank you,
    Janice

Leave a Reply

Your email address will not be published. Required fields are marked *