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Pos

sandyy2510

Networker
Messages
39
Location
Jamaica/ Manhattan
Best answers
0
I have a denial for an OPEN hysterectomy done as ambulatory surgery (under 23 hours stay) the rational of this denial is inappropriate place of service, as they are always done inpatient. Can anybody tell me who assigns the POS for surgical procedures?? I looked on the AMA web site and they have no info regarding the various place of services
 

mbort

True Blue
Messages
2,338
Location
ENGLEWOOD/DENVER
Best answers
0
I'm assuming you used 24 for the POS which would be correct.

I have had this happen to me in the past. It is generally a carrier/contract issue. I had to appeal mine with our carrier, fighting tooth and nail, to get them to pay our claim because we did not have any specific procedure restrictions on what we could and couldn't do in our ASC per the contract. They eventually paid.

I would double check your contract for procedure restrictions and then appeal it.
 

sandyy2510

Networker
Messages
39
Location
Jamaica/ Manhattan
Best answers
0
They are using the NY state health department, CMS, and medical ethical protocol as the reasons not to pay, they don't say anything about our contract.
 
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