Billing for Procedure with two POS

anturner

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Hello,

This is more of a personal question since it pertains to my father but I wanted to get some other opinions as well.

My dad had a prostate biopsy done in his doctors' office. They billed the same procedure codes with POS as office, and again billed with with POS as hospital. We contacted the office because I don't think this is correct (I feel it should be one or the other) and they are saying that it was billed correctly because "for the convenience of the patients," they have one room in their office that is considered an operating room so the patient doesn't have to go to the actual hospital to have the procedure done.

Has anyone heard of such a thing?? I feel like this is double dipping and I don't understand how you can bill for the same procedure twice. The "office" claim was paid in full by the insurance but the one billed as hospital applied entirely to the deductible so my dad has a bill for $2200. I'm going to write an appeal to the insurance, but wanted to see what other's thought first.

Thanks!
 

mitchellde

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Columbia, MO
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The POS of 11 for office reimburses the office for the overhead and other incurred expenses. If they need to split the fee due to the separate room then they must split the charge as a 26 and tc charge.
 

thomas7331

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If the physician's office is owned, staffed and operated by a hospital and designated as a 'hospital outpatient department', this is what's called 'provider based billing' which is allowed, and every service or code will generate two charges - one for the physician's work and one for the facility's costs. These don't overlap and it would not be double billing. That's a little different than what you've described as the same code being billed with 'two POS' - you can't bill the same service twice with two different POS codes - that would be a duplicate charge. Best to contact the provider to have them review the bill for any possible errors and to give you clarification on what the two charges are for.
 

CodingKing

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The place of service should be the same for both the faclity and physicians fee. Sometimes there are physician owned surgery centers. It would be separate TINs and NPI's but with place of service 24. If its a Hospital Outpatient Department i would expect the facility charge to be billed by the hospital, not the physican. Also the physician under that circumstace would use POS 22 sicne they dont have the same overhead as if it were an Office.
 
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