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Thread: NH Patients treated in OP Clinic

  1. #1

    Unhappy NH Patients treated in OP Clinic

    AAPC: Back to School
    Hi All!

    I know the answer to my question; however, I am looking for some supporting documentation as I have a clinic that is challenging me because I am new here and they have done "tons" of research on this. Here is the scenario:

    Patient is a resident of a nursing home. Family member decides to transport the patient to the physician's outpatient clinic for an acute problem.

    Seems pretty straight-forward right? I would bill this with the appropriate outpatient E/M level and POS 11.

    The clinic is billing this with a nursing home E/M and POS 32.

    I've tried explaining to them that this is not appropriate coding, but they look at me like I have two heads

    Any documentation that you can point me too other than the CPT book, which I've already reviewed with them, would be greatly appreciated!

    Thanks so much!


  2. #2
    Join Date
    Apr 2007
    Concord, NC or Rochester, NY


    I would think this is quite simple - the location is not at the nursing home.

    Here are Medicare definitions:

    11 Office
    Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis.

    32 Nursing Facility
    A facility which primarily provides to residents skilled nursing care and related services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care services above the level of custodial care to other than mentally retarded individuals.

    The office is not providing a service at the nursing facility to the residents and someone is bringing the patient to the office so hence the location is office (11)

  3. #3


    Thanks Michael! It is quite simple, like I said I was just looking for some further "back-up".

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