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PCs' Denying for Wrong POS

  1. #1
    Unhappy PCs' Denying for Wrong POS
    Medical Coding Books
    Hey everyone, i need your opinion on how to handle this situation... I do coding for a CRNA based group that goes to a urology facility in ohio for services. The insurance company, Anthem Blue Cross/Shield--Wellpoint is deing the codes that i use stating the are invaild place of service. I have to use "11" for office setting, for which, the facility is. The surgeon does get paid but anesthesia does not, it has to be under an outpt service, or ambulatory service center?? Please help me We are loosing soo much money because our claims are sitting in insurance que denying.
    Any help would be greatly appreciated.


  2. Default
    It sounds as if this is a general practice across the board for all the Blues. Here in NC, BCBS will also not allow for anesthesia in an office setting. We inform the patient of this prior to the procedure, have them sign a waiver, and then collect for this fee upfront. Patients are generally willing to pay for the convenience of having procedures performed in the office rather than going through the arduous process at the hospital or ASC and incurring those additional costs as well.

  3. Default
    Have you talked to provider relations at the insurance company? I would suggest this approach, to clarify for them what is happening and to find out how they want it reported.

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