Wiki 99490 Denial for invalid place of service

[greatbiller]

Hello everyone.

I am working aging for a family practice client. Family practice is not my primary area of experience, so please forgive me.

We are seeing multiple claims for 99490 deny for invalid place of service. I called Railroad Medicare on one patient and spoke with a representative and she said this particular patient was a hospital inpatient on the date of service we billed, so the claim denied.

How do we resolve this issue? My initial instinct is to send a corrected claim with hospital inpatient place of service code, but since we normally see this patient in the office, that would not be correct as the way I am interpreting the rules, 99490 is billed with the place of service that corresponds with where the provider would normally see the patient.

Again, primary care is not my primary specialty that I work, so I appreciate any and all suggestions/recommendations!

 

[HeatherMM]

Whitney AAPC-TEST

 

[HeatherMM]

If you look at CMS FAQs for CCM services and billing of 99490 you will find 2 questions that seem to answer your question about DOS and POS for the claims:
What date of service should be used on the physician claim and when should the claim be submitted? The service period for CPT 99490 is one calendar month, and CMS expects the billing practitioner to continue furnishing services during a given month as applicable after the 20 minute time threshold to bill the service is met (see #3 above). However practitioners may bill the PFS at the conclusion of the service period or after completion of at least 20 minutes of qualifying services for the service period. When the 20 minute threshold to bill is met, the practitioner may choose that date as the date of service, and need not hold the claim until the end of the month.
What place of service (POS) should be reported on the physician claim? Practitioners must report the POS for the billing location (i.e., where the billing practitioner would furnish a face-to-face office visit with the patient). Accordingly, practitioners who furnish CCM in the hospital outpatient setting, including provider-based locations, must report the appropriate place of service for the hospital outpatient setting). Payment for CCM furnished and billed by a practitioner in a facility setting will trigger PFS payment at the facility rate.

I hope this helps you get the claims paid.

 

[greatbiller]

If you look at CMS FAQs for CCM services and billing of 99490 you will find 2 questions that seem to answer your question about DOS and POS for the claims:
What date of service should be used on the physician claim and when should the claim be submitted? The service period for CPT 99490 is one calendar month, and CMS expects the billing practitioner to continue furnishing services during a given month as applicable after the 20 minute time threshold to bill the service is met (see #3 above). However practitioners may bill the PFS at the conclusion of the service period or after completion of at least 20 minutes of qualifying services for the service period. When the 20 minute threshold to bill is met, the practitioner may choose that date as the date of service, and need not hold the claim until the end of the month.
What place of service (POS) should be reported on the physician claim? Practitioners must report the POS for the billing location (i.e., where the billing practitioner would furnish a face-to-face office visit with the patient). Accordingly, practitioners who furnish CCM in the hospital outpatient setting, including provider-based locations, must report the appropriate place of service for the hospital outpatient setting). Payment for CCM furnished and billed by a practitioner in a facility setting will trigger PFS payment at the facility rate.

I hope this helps you get the claims paid.

Thank you!!!! I must have missed that section when I was doing my research. Have a wonderful weekend!!!