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Wiki 96372

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KaylaRieken

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Waukee, IA
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I have a doctor who does an outreach clinic at an outpatient hospital. His nurse administered a medication and I am getting denied saying it was an inappropriate place of service. Can this administration code not be used in a facility setting?
 
The payer is correct - an injection, or other service done by an employee of a physician can only be billed when performed 'incident to' the physician. 'Incident to' billing is not allowed in a facility setting, because all non-professional services performed within the facility are considered a facility expense and should be billed by the facility on the UB claim. The exception would be if your physician is leasing space from the hospital and operating it at his own expense, in which case that location would be considered an office and billed as such.

You may wish to have your provider discuss this with the facility - it is likely against the facility's internal guidelines to allow an outside nurse to perform services within the hospital - nurses who are not hospital employees are not typically given privileges to evaluate patients and/or perform services within a hospital. The facility's own nurses should be doing this.
 
thomas7331 said:
The payer is correct - an injection, or other service done by an employee of a physician can only be billed when performed 'incident to' the physician. 'Incident to' billing is not allowed in a facility setting, because all non-professional services performed within the facility are considered a facility expense and should be billed by the facility on the UB claim. The exception would be if your physician is leasing space from the hospital and operating it at his own expense, in which case that location would be considered an office and billed as such.

You may wish to have your provider discuss this with the facility - it is likely against the facility's internal guidelines to allow an outside nurse to perform services within the hospital - nurses who are not hospital employees are not typically given privileges to evaluate patients and/or perform services within a hospital. The facility's own nurses should be doing this.
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What about when the physician administers the injection at an ASC? We have been getting denials for invalid POS for 96372.
 
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