Place of Service Coding

[am1976]

Help!

I bill for professional services and I need to know if I am coding correctly the Place of Service.

The doctor is contracted with the hospital and works in a clinic owned by the hospital. The clinic is not inside the hospital but is only a couple blocks away.  I bill the following to Medicare:

CPT 99183  and POS 22 Out/PT in a hospital setting.  Is this right? If not what should I do bill office POS 11?

Also, should I notify Medicare if I have been billing incorrectly. I've been doing this for more than two years now and never had a problem. Will this make a difference in payment?  The hospital being the owner of the clinic bills for facility.

Thanks in advance for your help!

[Michele]

99183 is for hyperbaric chamber, is that what the clinic is?  Are you billing under the hospital name and EIN/NPI?  It really depends on how you are billing (under hospital name) and how the insurance carriers have you on their provider files.  If you are 'part of' the hospital then the 22 would be appropriate but if you are a stand alone clinic, set up that way with insurance carriers then the 11 may be correct.

Need more info to be sure.

[am1976]

Thanks Michelle for the response.

My doc is contracted with the hospital. The hospital owns the HBO clinic and it is located a few blocks away from the hospital.  He does not pay rent or employee salaries for the clinic. He only supervises the HBO treatments and we only bill for his professional services using CPT 99183 and POS 22.

Other responses I've received so far seem to indicate this is correct. If this correct is there a way we can bill POS 11 and use some modifier to communicate to medicare and other carriers that he does not rent/own the space and pays no overhead.

[Michele]

So you are billing the professional charges for the HBO?  Is the hospital billing for the use of the facility?  If they are, then you would use the same POS that they use on the facility charges.  You shouldn't use 11 if they are classified as a hospital.  The 22 would be more appropriate then.

[pattil88]

The Medicare fee schedule takes into account the difference in the allowable amount received for POS "22" versus "11". Our Medicare Carrier (BCBS of Alabama) has an allowance under the "Facility" column in the fee schedule for services rendered in the outpatient hospital setting, and then another allowance under the "Non-Facility" column for services rendered in the doctor's office. For 99183 in Georgia, the allowance is $116.16 in POS 22, and $195.91 for POS 11.  Some fee schedules may also refer to this as the "site of service" differential in their allowances.