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Thread: Place of service 22 vs. 11

  1. #1
    Join Date
    Apr 2007
    Location
    Aurora, IL
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    Default Place of service 22 vs. 11

    AAPC: CPC Promo
    Hello. I wasn't sure where to post this question so I'm posting in two places in hopes that someone can help me out.

    We have an oncology center that has physician offices (place of service 11)on one side of the building and then the patients get their infusion done across the hall in the hospital outpatient infusion center (place of service 22). My question is, if a patient sees the doctor and we bill an E/M code for the physician office service, then the patient goes across the hall to have chemo in the outpatient infusion center (POS 22), do we use a modifier 25 on the office visit? We have a few denials from our state Medicaid carrier and I can't find any documentation to tell me if we use this modifier even though the place of service is completely different for each charge. HELP please!!!
    Chrissy, CPC

  2. #2

    Default 25 modifier

    Quote Originally Posted by HILLIC View Post
    Hello. I wasn't sure where to post this question so I'm posting in two places in hopes that someone can help me out.

    We have an oncology center that has physician offices (place of service 11)on one side of the building and then the patients get their infusion done across the hall in the hospital outpatient infusion center (place of service 22). My question is, if a patient sees the doctor and we bill an E/M code for the physician office service, then the patient goes across the hall to have chemo in the outpatient infusion center (POS 22), do we use a modifier 25 on the office visit? We have a few denials from our state Medicaid carrier and I can't find any documentation to tell me if we use this modifier even though the place of service is completely different for each charge. HELP please!!!
    I believe you do need the 25 modifier indicating it's a separte e/m service from the chemo services. I'm not familiar with chemo coding but I would also check the medicare lcd on the chemo codes to see if it includes e/m services.

    http://www.ngsmedicare.com/wps/portal/ngsmedicare/mpc

  3. #3
    Join Date
    Apr 2007
    Location
    Greater Portland (Maine)
    Posts
    128

    Default

    The infusion is a facility charge, so no 25 modifier would be needed on your professional E&M. Is your oncology practice hospital-owned? If so, I believe the POS would be 22 for both services. In that case, the office visits would be divided into professional and facility charges for Medicare/Medicaid patients, and a 25 modifier would be required on the facility E&M when infusion services are provided on the same day.
    RCBartholomew, CPC-H, CEDC

  4. #4
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    12,088

    Default

    Medicare will routinely deny an office visit on the same day as Chemo unless you can support that the patient was seen for reason unrelated to the chemo. so you should appeal if you have this documentation, the provider will not use a 25 modifier as the infusion is billed by the facility and the facility will not be billing for an E&M when the patient is there for scheduled chemo.

    Debra A. Mitchell, MSPH, CPC-H

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