Radiology POS Question


Milwaukee, WI
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Issue: The patient had x-rays taken during a physician office visit. The physician then sent the x-ray out for interpretation. The interpretation was billed with a POS 22 Outpatient Hospital, thus subject to the patient's ded/coinsurance. The patient disagrees, stating that the claim should have been processed applying the office visit co-pay, not ded/coins as the patient was not treated in the hospital. The patient believes that the claim should have been billed with a POS 11. My understanding has always been that interpretations are billed based on where the service was interpreted. Most radiologists & pathologists are hospital based and do bill POS 22 - is my understanding correct?? Any clarification or guidance would be much appreciated. Also, if anyone can provide me written clarification, such as the CMS link indicating how such a scenario should be appropriately billed that would be very helpful, as this patient is the type that would be seeking something in writing to "prove" that the service was billed appropriately.

Shelly L. Kubacki, MPA, CPC
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Per Medicare Claims Processing Manual (100-04) , Chapter 13 Section 150:

Many of the diagnostic services, including radiology services, provided by physicians/practitioners contain both a technical component (TC) and a professional component (PC). Often, the PC and TC of diagnostic services are furnished in different settings. As a general policy, the POS code assigned by the physician/practitioner for the PC of a diagnostic service shall be the setting in which the beneficiary received the TC service.

Hope this helps.

L. Lauer COC