Wiki Place of Service question

Create Wiki
B

bethb

Guru
Messages
121
Location
Beaver Falls, PA
Best answers
0
Our general surgeon billed a 62223-62, co-surgeon, with a place of service 22, outpatient hospital. We received a denial from the insurance carrier (Insurance carrier is a commercial plan, not Medicare or Medicare Part C) advising the procedure is not usually "in" the place of service reported, per CMS guidelines.

I checked into the code and found it has an ASC payment indicator of C5-inpatient procedures.

Can anyone help me with this question--Is payment of services under the Medicare Physician Fee Schedule indicative of payment indicators for ASC / OPPS? i.e. the denial we received for professional services (62223) is being based on Ambulatory Surgery Center payment indicator rules.

Thanks!
 
Some procedures are designated as inpatient only. This is something you need to research befor the procedure is performed. Now that it is done the only thing you can do is research to find credible evidence that supports this procedure can be safely performed in an outpatient setting. They usually respect sources such as the New England Journal of Medicine or the AMA.
 
You must log in or register to reply here.
Top