Question Independent Laboratory-POS Question

Tara0513

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I work for an independent laboratory, and recently we have been receiving numerous denials and requests for medical records. They are stating that we should not be billing POS 81 unless we are the ones collecting the specimen, otherwise we have to bill place of service according to where the specimen was obtained? I am completely confused by this because we are processing the specimen that has been sent to us by surgery centers or office visits, so i would assume we use 81(independent laboratory) not where the specimen was obtained. Please anyone having this issue? Any insight?
 

SharonCollachi

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Here is one mention (click me for full reference):

United Healthcare Medicare Advantage uses the codes indicated in the CMS Place of Service (POS) Codes for Professional Claims Database to determine if laboratory services are reimbursable. The POS designation identifies the location where the laboratory service was provided, except in the case of an Independent or a Reference Laboratory. An Independent or Reference Laboratory must show the place where the sample was taken (if drawn in an Independent Lab or a Reference Lab, POS 81 is reported; if drawn in a hospital inpatient setting, the appropriate inpatient POS is reported).

All entities billing for laboratory services should append identifying modifiers (e.g., 90), when appropriate, in accordance with correct coding. For example:
•If the physician bills for lab services performed in his/her office, the POS code for "Office" is reported.
•If the physician bills for a lab test furnished by another physician who maintains alab in his/her office, the code for "Other Place of Service” is reported.
•If the physician bills for a lab service furnished by an independent lab, the code for "Independent Laboratory" is reported.
•If an independent lab bills, the place where the sample was taken is reported. An independent laboratory taking a sample in its laboratory shows "81" as place of service.
•If an independent laboratory bills for a test on a sample drawn on an inpatient or outpatient of a hospital, it reports the code for the inpatient (POS code 21) or outpatient hospital (POS code 22), respectively.
 

Tara0513

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Here is one mention (click me for full reference):

United Healthcare Medicare Advantage uses the codes indicated in the CMS Place of Service (POS) Codes for Professional Claims Database to determine if laboratory services are reimbursable. The POS designation identifies the location where the laboratory service was provided, except in the case of an Independent or a Reference Laboratory. An Independent or Reference Laboratory must show the place where the sample was taken (if drawn in an Independent Lab or a Reference Lab, POS 81 is reported; if drawn in a hospital inpatient setting, the appropriate inpatient POS is reported).

All entities billing for laboratory services should append identifying modifiers (e.g., 90), when appropriate, in accordance with correct coding. For example:
•If the physician bills for lab services performed in his/her office, the POS code for "Office" is reported.
•If the physician bills for a lab test furnished by another physician who maintains alab in his/her office, the code for "Other Place of Service” is reported.
•If the physician bills for a lab service furnished by an independent lab, the code for "Independent Laboratory" is reported.
•If an independent lab bills, the place where the sample was taken is reported. An independent laboratory taking a sample in its laboratory shows "81" as place of service.
•If an independent laboratory bills for a test on a sample drawn on an inpatient or outpatient of a hospital, it reports the code for the inpatient (POS code 21) or outpatient hospital (POS code 22), respectively.
Hi Sharon!
Thank you for your response.
Yes I read this as well. I am just confused as to why? We have nothing to do with the referring physicians we are a separate entity (think like LabCorp/Quest) so why should we put the POS as to where the specimen was retrieved and not the lab 81 where we are processing and staining the said specimen. If this is the case where we have to put POS where the specimen was obtained what do put in the HCFA claim boxes 32 and 33 ( I believe those are the boxes)? The name of our practice as rendering and billing? This whole situation is crazy to me. We are being inundated with medical records requests and denials.
 

SharonCollachi

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The place of service code is generally designed to indicate where the patient received face-to-face services. If the specimen was not drawn in your lab, then that is not where the patient received services. Here's an older letter that talks about it: https://www.acla.com/letter-to-cms-regarding-pos-policy/

You cannot bill box 33 with anything but the billing entity's information; that is who will get paid.

Box 32 contains your address.
 

Tara0513

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Sharon,

Thank you so much for all the information. Even though I questioned I am extremely grateful. I have to question bc I know the providers will question me. So again thank you!
 

danachock

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Hi, "back in the day" when I have dealt with POS issues it is because the claim didn't align properly. We billed our charges from Epic and both the Service and Billing Provider had to be assigned "independent lab - whatever location you are dealing with" and the Service location and POS both had to bill the same
"independent lab same location" as the Billing and Service location.
We were billing the lab received charges with POS 81.
However, If you are trying to bill a venipuncture too with the lab specimen received it simply doesn't work with POS 81. Creating that other account to bill the VEN solo resolved it.
Also, after the claim generates, are you able to review it and ensure you have POS 81 and Independent Lab in those fields?
Thank you for listening,
Dana
 

imchavez

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El Paso, TX
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I work for an independent laboratory, and recently we have been receiving numerous denials and requests for medical records. They are stating that we should not be billing POS 81 unless we are the ones collecting the specimen, otherwise we have to bill place of service according to where the specimen was obtained? I am completely confused by this because we are processing the specimen that has been sent to us by surgery centers or office visits, so i would assume we use 81(independent laboratory) not where the specimen was obtained. Please anyone having this issue? Any insight?
use pos 49.
 
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