Author Topic: Question about Place of Service Codes  (Read 2317 times)

gurumedbill

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Question about Place of Service Codes
« on: May 23, 2013, 10:47:52 AM »
This is kind of a silly a thing but I've always wondered about it so I need your help.  In box 24 of a claim form column B is for the place of service.  The place of service (POS) is specific to each line item.  However, in box 32 we have the facility where the services were rendered.  So my question is this: Is there ever a time when there would be multiple line items in box 24 when they didn't all have the same POS.  I guess I'm wondering why the POS is put in box 32 instead of box 24.  Thanks for your help.  I'll be able to sleep much better if you can all help me with this.  :)

Please respond to this even if you don't know of a circumstance.  In other words, if you read this just respond with "I don't know a situation" or "I do know a situation and here it is...".

THANK YOU!

rdmoore2003

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Re: Question about Place of Service Codes
« Reply #1 on: May 23, 2013, 11:16:15 AM »
box 24b is pos like for office is 11.   box 32 is the location information, like address etc.     You cannot put pos in 24b of 11(office) and then put a facility address,,,do you get what i am saying?   I hope that I am misunderstanding this question.
Regina

RichardP

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Re: Question about Place of Service Codes
« Reply #2 on: May 23, 2013, 11:36:11 AM »
Box 24b is for the Place of Service type.  See the link.

http://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html

Box 32 is for the Place of Service location (address), just as it says in the Box 32 heading.

As rdmoore2003 stated, the Place of Service type needs to be consistent with the Place of Service location.  You wouldn't place "01" (pharmacy) in Box 24b and your office address in Box 32.

gurumedbill

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Re: Question about Place of Service Codes
« Reply #3 on: May 23, 2013, 01:16:32 PM »
box 24b is pos like for office is 11.   box 32 is the location information, like address etc.     You cannot put pos in 24b of 11(office) and then put a facility address,,,do you get what i am saying?   I hope that I am misunderstanding this question.

Box 24b is for the Place of Service type.  See the link.

http://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html

Box 32 is for the Place of Service location (address), just as it says in the Box 32 heading.

As rdmoore2003 stated, the Place of Service type needs to be consistent with the Place of Service location.  You wouldn't place "01" (pharmacy) in Box 24b and your office address in Box 32.

I apologize for not being clear.  I understand all of that but my question is why is POS line item specific.  Is there ever an instance where there would be two transactions in box 24 and each of them have a different POS.  I can't think of a situation where that would happen.  This makes me wonder why the POS code is on each line item and not in box 32 or some other place on the claim that lets the insurance know that all of the transactions were done at an office (11) or a hosptial (21).  Does that make sense?

RichardP

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Re: Question about Place of Service Codes
« Reply #4 on: May 23, 2013, 03:37:23 PM »
Some charges can be performed at more than one location.  Some charges would logically be performed at one location but not at another.  Insurance Carriers data-mine their electronic data to find out how many of each charge is performed at each location.  They also do edits, and reject charges that are performed at non-natural locations (a colonoscopy wouldn't logically be performed at a school, so an edit would likely reject that combination).  So - we see that Insurance carriers want a POS connected to each charge submitted, for the purpose of data mining and for the purpose of edits.

Is there ever an instance where there would be two transactions in box 24 and each of them have a different POS.  I can't think of a situation where that would happen.  This makes me wonder why the POS code is on each line item ...

Our billing software is set up so that Box 32 is linked to Box 24b.  What the software places into Box 32 depends directly on what is in Box 24b.  The fallout of this is that only items with the same Code for Box 24b show up on the same CMS 1500 form.

Assume we have put into the billing software 15 different charges for a specific doctor, five charges each at three different locations (this does happen with some of our clients).  The software sorts the 15 charges based on the code in Box 24b (or we can sort manually).  After sorting, we end up with three groups of five charges.  For example, five charges all coded "11" (office); five coded "21" (inpatient hospital) and the last five coded "24" (ambulatory surgical center).

All five charges with the same code in Box 24b and location in Box 32 go on one CMS 1500 form; the next five charges with the same but different code in Box 24b, and different location in Box 32, go on a different CMS 1500 form.  And the same for the last five charges with the same but different code in Box 24b.  (All "11"s on one form; all "21"s on another form; all "24"s on the last form.)

We need a code in Box 24b for each charge to be able to do this.  That code is actually entered into the billing software when the charges are entered.  Our software allows us to attach a default POS code to each CPT.  When we type in the CPT code, the default POS shows up, but it can be changed if necessary.

So - your basic premise is correct.  Since only those charges that have the same POS code show up on a given CMS 1500 form, there could be just one box that shows this POS code per CMS form - so far as you or I are concerned.  However, the Insurance Carriers want the POS code attached to each charge, for their own purposes.  So we end up with the CMS 1500 form designed the way it is. 

If you know database design, you know the concept of records and fields.  For electronic billing, the concept of lines is irrelevant.  We simply know that the software is designed to put the proper POS field into the same record as the CPT code field when it is submitted to the Clearinghouse.  But for paper, each line that is scanned will be turned into a seperate electronic data record.  Therefore, in order to be contained in the same data record as the CPT code, the POS field needs to be on the same line as the CPT code field.  So again, we end up with the CMS 1500 form designed the way it is.

gurumedbill

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Re: Question about Place of Service Codes
« Reply #5 on: May 23, 2013, 04:32:48 PM »
Richard,

Thank you for the explanation.  I never thought about data mining but that makes perfect sense.  Our PMS also has a default POS setup on the CPT level that can be changed but I never really could figure out why it was necessary.  Data mining does make sense.  Thanks again, I can now sleep better tonight. :)

RichardP

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Re: Question about Place of Service Codes
« Reply #6 on: May 23, 2013, 05:11:22 PM »
 :)  Watch out for asteroids.

Merry

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Re: Question about Place of Service Codes
« Reply #7 on: July 01, 2013, 08:51:05 PM »
As you already know, you can only use one facility other than home or office on a CMS 1500 form. BUT..it should also be noted that reimbursements can differ depending on the POS that the procedure was performed. A cystoscopy that is performed in an outpatient facility is usually reimbursed at a higher rate than one that is performed in a medical office. Same procedure..different POS for reimbursement issues. Just thought I would add my 2 cents here.