New POS Code Adds Specificity to Outpatient Hospital Departments

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.

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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

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Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

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Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

3 Responses to “New POS Code Adds Specificity to Outpatient Hospital Departments”

  1. Sandy says:

    POS 19 starts on January 1, 2016. Is that for dates of service from 1-1-16 going forward only? For instance, I am still working on the end of December 2015 charges ….. should we use POS 19 for those?

  2. Beth Gifford says:

    I too would like clarification if the new POS code 19 is for date of service or the actual date billed. As the example above for DOS 12/2015 being billed after 1/1/16.
    Thank you

  3. Sarah Stowe, CCS-P says:

    According to the MLN transmittal it is all claims processed after 1/1/2016 not by DOS.
    https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM9231.pdf

    MLN Matters® Number: MM9231
    December 9, 2015
    “Revised to clarify the effective date of POS 19. POS 19 will be accepted for any claims processed on or after January 1, 2016. That is, POS code 19 is valid for any claim regardless of the date of service when it is processed on or after January 1, 2016.

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