Rehab patients coming to office coding question


Best answers
I have conflicting information regarding when a patient who is in an IP Rehab or a SNF coming into the office to be seen.

I understand that place of service needs to match patient status - so if the rehab transports them to my office, they are still a rehab patient, POS 61. The office visit E&M code is the 99201-99215, correct? No modifiers or anything else, correct?

Here's one of my situations as an example: patient is IP Rehab recovering from a stroke. Came to my urology office to see the doctor regarding his retention. Originally a 99203 was billed to Medicare POS 11. Medicare paid and now wants their money back because of the rehab. So, to correct this claim, it would be 99203, POS 61 and goes back to Medicare, not the Rehab, correct?

I always thought Rehabs/SNFs pay on procedures not office visits, but my supervisor seems to think otherwise. She said to change the E&M to a HOSPITAL code (99221-99233) and bill the rehab. Somehow that seemed off to me, and the MLN Matters #7631 seems to back my thought, but since I haven't done much with SNF/Rehabs until now I just would like confirmation that I understand what to do.