Wiki Hospital based Clinic POS

[bethany.tapp]

I work for a physician practice and we staff a hospital based clinic. We are not part of the hospital - we only provide services at the clinic. For our professional billing, does the POS have to be 22? We are seeing denials on 95044 due to invalid place of service. I am not sure what to do.

 

[thomas7331]

I'd need a little more information to answer this because it depends on the status of your clinic and its arrangement with the hospital. If your clinic leases the space from the hospital and your staff there are employees of the physician practice, then you should be billing place of service 11 - in that situation you are not actually providing services in the hospital - your clinic is located on the hospital grounds, but you are still an independent practice. If you've been billing POS 22 under this situation, then you're probably being underpaid for all of your services. If however, the clinic is operated by the hospital and the staff are hospital employees, and the physicians there are only providing professional services and not incurring any costs to themselves for the operation of the clinic, then you would bill place of service 22, and the hospital would bill its own costs on a separate facility claim.

95044 is an 'incident to' service, so in a hospital location, this would be billed by the facility only on the UB-04 claim - there is no separate professional component to this code, so you would not bill this under the physician since the cost of providing this service is only associated with the facility - if you bill this code on a professional claim with POS 22, it would be expected that this code would be denied. Let me know if that helps answer your question.

 

[bethany.tapp]

Thomas, this is perfect! We are scenario #2 and it sounds like we need to stop billing this code. Thank you so much for the quick response.