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Place of Service - E/M Encounter

  1. #1
    Default Place of Service - E/M Encounter
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    Hi,

    What would be your place of service code for E/M codes 99201-99204; 99212-99215 if rendered in an outpatient doctors office/practice situated in the hospital? Would you do 11 or 22? Let's say the providers/group is contracted with the hospital, and the the physician's office is renting the the office from the hospital.

    Regardless what POS code would be, is there a difference in terms of the reimbursement?

    I just would like to know what are your thoughts on this.

    Thank you much!

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default Hospital clinic
    If you are renting your space from a hospital AND you are providing all the fixtures, nursing/med tech personnel, xray equipment, etc. then you are in POS 11.

    If you are using a hospital clinic, and the hospital owns all the equipment, employs the nurses, clinic manager, techs, etc., then your POS is 22.

    There are some codes that you will not be able to use if you are in POS 22 (for example chemotherapy admin codes are "not intended to be reported by the physician in the facility setting."

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 11-23-2009 at 01:56 PM.

  3. #3
    Default
    Hi,

    Thank you for your reply. But is there some guidelines out there regarding this? I have been trying to find literature on this. I actually have the same thought. But again, wouldn't it be nice if there is really something written or some guidelines. I already navigated the CPT books and the CPT Changes books... I couldn't find anything.

    I hope anyone can share if they happen to know where we can get it?

    Thank you.

  4. #4
    Default
    I don't know of any printed guidelines, but the POS just comes down to who's paying the bills for the real estate and staff. If a hospital is paying those bills, then the POS is a hospital. If a physician is paying, then it's an office setting.

    A private practice can rent space from a hospital, but since the practice is paying the costs, the place of service is "office". Even if it's fully enclosed by the surrounding hospital, it's still a private practice, therefore POS 11.

    If I find anything written to back this up I'll post it here..

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default Facility fee?
    Is the hospital submitting a faclity fee for each encounter?

    If YES, then you are in POS 22.

    If NO, then you are in POS 11.

    F Tessa Bartels, CPC, CEMC

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