bethb
Guru
Good morning! Could anyone out there please help me try and understand Medicare's Place of Service Coding Instructions / exceptions.
Our physician saw a patient in the office and our billing was submitted to Medicare status quo--place of service 11, outpatient E/M code was submitted. Medicare denied stating invalid place of service billed. Did some digging and found the patient, at the time of the office visit, was under an inpatient admission at an inpatient rehabilitation hospital. So I did some more research and found an MLN Matters titled Revised and Clarified Place of Service Coding Instructions.
From what I am reading in the MLN Matters, I think the claim needs billed with a Place of Service 21 because the patient was status inpatient at the time of service. But I am confused now as to how this could be done. Would the E/M stay as an outpatient CPT code (eg. 99212) and the facility remain our physician's office (in block 32 of a CMS form) but the place of service be a 21? Could that even work?
Perhaps I am interpreting what I read incorrectly. Does anyone have any experience with this kind of scenario or have any knowledge they could share?
Thank you all in advance!
Beth
Our physician saw a patient in the office and our billing was submitted to Medicare status quo--place of service 11, outpatient E/M code was submitted. Medicare denied stating invalid place of service billed. Did some digging and found the patient, at the time of the office visit, was under an inpatient admission at an inpatient rehabilitation hospital. So I did some more research and found an MLN Matters titled Revised and Clarified Place of Service Coding Instructions.
From what I am reading in the MLN Matters, I think the claim needs billed with a Place of Service 21 because the patient was status inpatient at the time of service. But I am confused now as to how this could be done. Would the E/M stay as an outpatient CPT code (eg. 99212) and the facility remain our physician's office (in block 32 of a CMS form) but the place of service be a 21? Could that even work?
Perhaps I am interpreting what I read incorrectly. Does anyone have any experience with this kind of scenario or have any knowledge they could share?
Thank you all in advance!
Beth