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Scopes in the office-what POS and Modifier?

  1. Default Scopes in the office-what POS and Modifier?
    Medical Coding Books
    I have a doctor who purchased all the equipment to do Colonoscopies in his office. He has been approved and performing them for a year or so. I am trying to understand is this considered an ASC?
    Currently his AR is a mess. I am trying to clean it up. His EGD's and colonoscopies have been coded many different ways. They have had POS 22 or 24 for the "Endoscopy Suite" and 11 for the actual charges for the physician.
    I am thinking the Endo Suite (different tax id than the provider) should be billed with a POS 24 and the codes have a TC modifier, and the physician's fees should be billed with a POS 24 and modifier 26. OR should they be POS office (11) with the modifiers described above?



  2. #2
    All office-based endoscopies are billed on one claim with the place-of-service of office (11). The facility portion of your reimbursement is included in the higher practice expense RVUs associated with the office setting. For example as illustration, the 2011 fee schedule for colonoscopy, 45378, in Ohio is $390.67 in the office setting and is $222.52 in the facility setting.

    Endoscopies do not have technical components (TC) or professional components (26) as other diagnostic GI services do (example esophageal motility).

    If it is, in fact, a separate, Medicare certified ambulatory surgery center, those claims are billed separately and both the professional and facility claims are billed with POS 24.

    An office setting is NOT a facility. It is vital that these are billed with the correct POS to receive the appropriate reimbursement.
    Jenny Berkshire, CPC, CEMC, CGIC

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