New POS Code Adds Specificity to Outpatient Hospital Departments
Beginning January 1, 2016 the place of service (POS) code you report on Medicare/Medicaid claims for services provided to beneficiaries in outpatient hospitals might change. No longer will you report POS 22 when services are provided in an off-campus outpatient hospital. There’s a new code in town for that, and it’s called POS 19.
Both POS codes 19 and 22 describe a place where diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services are provided to sick or injured persons who do not require hospitalization or institutionalization. The only difference is that POS 19 has been created to specify services provided in a provider-based department off a hospital’s main campus. By contrast, POS 22 is for reporting services provided in the outpatient department on a hospital’s main campus. Claims for either POS are paid at the facility rate.
Payments for services provided to outpatients in either setting, who are later admitted as inpatients within three days (one day for non-Inpatient Prospective Payment System hospitals), are bundled when the patient is seen in a wholly-owned or wholly-operated physician practice. This payment window applies to all services clinically related to the reason for the patient’s inpatient admission, regardless of whether the inpatient and outpatient diagnoses are the same.
Source: MLN Matters® Article: MM9231