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Wiki OBSERVATION PATIENT CODING PLACE OF SERVICE

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KFLOYD

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Observation codes have been deleted for 2023. We have to crosswalk them to inpatient codes. 99221, 99222, 99223, etc. For dates of service beginning 1/01/23, the payers are rejecting the observation place of service, 22, stating that the 99221, 99222, etc, can only be used in POS 21. (CGS, Humana, etc)

Is anyone else receiving these rejections/denials? If we use 21, and the patient has a procedure the same day, under POS 22, then we'll get another rejection that the census reflects the wrong POS.

Any input would be appreciated.
 
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Every time there is a coding change there are always some payers who fail to update their claims systems to account for the changes. Once the error is identified and corrected , they usually go back and adjust all of the affected claims or updates their policies with guidance on how they want providers to bill. But this can take some time.

As we’re not even two weeks into the change yet, I would strongly advise against making any change in your coding or submitting any corrected claims yet. That will just compound the problem. Just keep putting pressure on these payers to either fix their errors or give you clear written policy that tells you how they require you to bill in these situations. If it’s happening to you, then it’s certainly going to be affecting many other providers as well.
 
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KFLOYD said:
Observation codes have been deleted for 2023. We have to crosswalk them to inpatient codes. 99221, 99222, 99223, etc. For dates of service beginning 1/01/23, the payers are rejecting the observation place of service, 22, stating that the 99221, 99222, etc, can only be used in POS 21. (CGS, Humana, etc)

Is anyone else receiving these rejections/denials? If we use 21, and the patient has a procedure the same day, under POS 22, then we'll get another rejection that the census reflects the wrong POS.

Any input would be appreciated.
Click to expand...
I'm experiencing the same problem as well!
 
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thomas7331 said:
Every time there is a coding change there are always some payers who fail to update their claims systems to account for the changes. Once the error is identified and corrected , they usually go back and adjust all of the affected claims or updates their policies with guidance on how they want providers to bill. But this can take some time.

As we’re not even two weeks into the change yet, I would strongly advise against making any change in your coding or submitting any corrected claims yet. That will just compound the problem. Just keep putting pressure on these payers to either fix their errors or give you clear written policy that tells you how they require you to bill in these situations. If it’s happening to you, then it’s certainly going to be affecting many other providers as well.
Click to expand...
thank you so much! I'm having the same problem as well!
 
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