New patient seen in specialty clinic. Patient status was inpatient.

kpichon

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Can anyone offer any direction on this problem? Provider saw patient in the specialty clinic of a hospital as a new patient. 99203 was billed with pos 11. Medicare denied for location as patient status was inpatient. Patient was apparently wheeled down from her room to the clinic.
 

mitchellde

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The POS must be where the patient is registered as a patient. Therefore if the patient is a registered inpatient then the POS must be 21 regardless of where the patient is physically seen by the provider. There is a transmittal from Medicare on this as well as a med learns matter and it is in the Medicare instructions. Just Google place of service instructions and you should find it.
 

kpichon

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kpichon Cpc, Centc

Thank you for your reply. I didn't think it was appropriate to bill for a hospital consult or hospital visit if the provider was not bedside or actually on the floor or unit. I'm thinking were just out the money on this one. I will check out the Medicare articles.
 

mitchellde

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If the patient is a registered inpatient and is brought to your office for evaluation you would use the office visit codes with the POS of 21. so a 99203 with POS 21. This is the appropriate way to bill. you will be paid as if you saw the patient in the facility at the bedside.
 

kpichon

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If the patient is a registered inpatient and is brought to your office for evaluation you would use the office visit codes with the POS of 21. so a 99203 with POS 21. This is the appropriate way to bill. you will be paid as if you saw the patient in the facility at the bedside.

Hello, Claim was rejected with Medicare for invalid Pos. 99203 billed with pos 21 did not work.
 

mitchellde

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Hello, Claim was rejected with Medicare for invalid Pos. 99203 billed with pos 21 did not work.
Your claim is correct. There is either something else wrong or you need to appeal here is what the Medicare manual on POS states:
Item 24B - Enter the appropriate place of service code(s) from the list provided in section 10.5. Identify the setting, using a place of service code, for each item used or service performed. This is a required field.
NOTE: When a service is rendered to a patient who is a registered inpatient or an outpatient (off campus or on campus) of a hospital, use the inpatient hospital POS code 21, Off Campus-Outpatient Hospital POS code 19, or On Campus-Outpatient Hospital POS code 22, respectively, as discussed in section 10.5 of this chapter.
Special Considerations for Services Furnished to Registered Inpatients

Section 10.5 states:
When a physician/practitioner furnishes services to a registered inpatient, payment is made under the PFS at the facility rate. To that end, a physician/practitioner/supplier furnishing services to a patient who is a registered inpatient, shall, at a minimum, report the inpatient hospital POS code 21 irrespective of the setting where the patient actually receives the face-to-face encounter. In other words, reporting the inpatient hospital POS code 21 is a minimum requirement for purposes of triggering the facility payment under the PFS when services are provided to a registered inpatient. If the physician/practitioner is aware of the exact setting the beneficiary is a registered inpatient, the appropriate inpatient POS code may be reported consistent with the code list annotated in this section (instead of POS 21). For example, a physician/practitioner may use POS 31, for a patient in a SNF receiving inpatient skilled nursing care, POS 51, for a patient registered in a Psychiatric Inpatient Facility, and POS 61 for patients registered in a Comprehensive Inpatient Rehabilitation Facility.
 
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