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Out patient vs. In Patient status Denials

  1. Default Out patient vs. In Patient status Denials
    Medical Coding Books
    I have a patient who was admitted by his cardiologist who will subsequently undergo CT surgery. The day following his admission our CTS interprets a CT and angiogram.

    We submitt the charges as inpt for the interpretations.

    We are receiving denials for place of service - procedure payable in outpatient setting for the interpretations.

    What are the guidelines for billing "out pt" procedures while the patient is in house? Can we change the place of service for the CT and Angiogram to Out pt hospital?

    Any thoughts would be appreciated.
    Steven G. Garza
    Practice Manager
    Methodist Physician Practices
    Texas Transplant Physician Group
    San Antonio, TX 78201

  2. #2
    Default loriz cpc
    I'v had this problem before. You should check to see what the insurance has as the admit date. The patient can technically be in house for a number of days and not an inpt. If they are technically still outpt then bill for out pt., but if the patient is an inpt having an outpt. procedure you make sure the place of service says inpt and appeal to the insurance co.

    Hope this helps

    Lori CPC

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