Wiki Place of Service Problem

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ebjohnson

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I am having trouble with my place of service code for IV antibiotic therapy. We are a physician office with an infusion suite and pharmacy. Most of our patients are able to take their medications home and administer themselves. We have been billing place of service 11 but sometimes are running into trouble with the patient being given a copay for every day they are taking the medication. I am weary of coding place of service 12 because we are not a home health agency. I am also not sure about using place of service 1 because we are not a free standing pharmacy. The medication is mixed here in the office and that has been the rationale behind choosing this place of service code. Most claims are paid fine but some are kicking out a copay. I am really getting frustrated with this. Any advise on this matter will be greatly appreciated if anyone has any experience with this.
 
Sorry but it is place of service 11, the fact that there is a copay is simply the way it is. You are billing the injection admin code and the drug only correct? Do not use a 99211.
 
What are you doing, exactly? Are you just mixing the drug and the pt takes it home for self administration? If you are just mixing the drug, then you should not be billing the admin. As for the co-pay, it is because you are billing from the Office.
 
Our office does home infusion as well. We always bill POS 11 even for the patients that take home the pumps.
I believe you are billing correctly it's just unfortunate the patients have the copay everytime.
 
mitchellde said:
Sorry but it is place of service 11, the fact that there is a copay is simply the way it is. You are billing the injection admin code and the drug only correct? Do not use a 99211.
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If the patient infused in the office we bill the admin code. If they take it home I just bill for the drug.
 
TiffanyParks said:
Our office does home infusion as well. We always bill POS 11 even for the patients that take home the pumps.
I believe you are billing correctly it's just unfortunate the patients have the copay everytime.
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That is what I was thinking. Of course, when the patient calls the insurance company they tell them it is because of the way that we billed it. But, there is no other way to bill it. Do your patients get hit with the copays too?
 
ebjohnson said:
If the patient infused in the office we bill the admin code. If they take it home I just bill for the drug.
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For the drugs you dispense for home use ... you say you have a pharmacy also.. then they should be billing out the drugs which are sent home as a dispensing pharmacy.
 
mitchellde said:
For the drugs you dispense for home use ... you say you have a pharmacy also.. then they should be billing out the drugs which are sent home as a dispensing pharmacy.
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The pharmacy is in the office. What is the place of service for that? 1?
 
ebjohnson said:
That is what I was thinking. Of course, when the patient calls the insurance company they tell them it is because of the way that we billed it. But, there is no other way to bill it. Do your patients get hit with the copays too?
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I have not had patients get copay unless we bill an office visit the same day. When we bill a nurse visit 99211 the patient doesn't seem to get a copay.
 
TiffanyParks said:
I have not had patients get copay unless we bill an office visit the same day. When we bill a nurse visit 99211 the patient doesn't seem to get a copay.
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I have noticed that most of the time they don't have a copay with the 99211 for us either. What services do your nurses perform when you bill the 99211?
 
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