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POS codes

  1. Default POS codes
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    My provider has hospital privileges and performs all kinds of codes as inpatient and outpatient. Though he has a tendency to bill codes in the office setting place of service11 and they are denied by Medicare because of the place of service. I'm told the code cannot be billed in an office setting. My provider wants to see these things in writing. When I ask Medicare for help finding these things in writing, they are unable to help. Between our coding software and the CPT books we have, I'm unable to see anything about these codes only being performed in a hospital setting. Is there a way I can find out if certain codes are only allowed in a hospital setting?
    Last edited by tbragg36; 10-16-2018 at 07:16 PM.

  2. #2
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    If I am reading this correctly your provider is performing the service in the facility setting but billing them as POS 11? If so that is the reason for the denial.. you must use the POS of where the patient is registered as a patient.
    If you are saying that he is performing in the office the same procedures as he performs in the facility and they are being denied as an inappropriate POS... then yes there are ways to get a list of the inpatient only procedures. You should be able to google this or go to the Medicare website and look up Medicare allowed inpatient only procedures.

    Debra A. Mitchell, MSPH, CPC-H

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