POS for 57410-Pelvic examination under anesthesia

hollomanh

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I have a question about valid places of service for CPT 57410. Our OB performed this in the office. This was the only procedure done on this date, so there isn't a bundling issue. Tricare is informing us that the claim was rejected due to an invalid POS and states it's an AMA rule. However, I have not been able to find anything that actually says that. Does anyone know if this is limited to certain places of service? They have denied the claim as unprocessable so will not even accept an appeal.
 

hollomanh

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What kind of anesthesia was used in the office?

Propofol and Toradol by a CRNA. And the CRNA billed his services as 00940. The service are bundled when performed by the same provider, but it was a CRNA that came in for the anesthesia portion. I started researching this further and found another case they did in the office where the provider was paid but the CRNA claim was denied for invalid POS.

I'm sorry, neither OB nor anesthesia are my strong points. Still learning as I go and the answer is probably staring me in the face. Thanks for your help.
 

tracylc10

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I am not an expert on this either, that being said, I am guessing that Propofol can only be administered in an ASC or Hospital. I don't believe it can be administered in the OB office.
 
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