Author Topic: Place of service for surgery....inpatient vs outpatient  (Read 1583 times)

footthebill

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Place of service for surgery....inpatient vs outpatient
« on: November 02, 2015, 11:05:34 AM »
Hello fellow medical billers/coders!
I need some clarification on a specific type of surgery POS situation.
I've researched this so much my eyes have gone cross-eyed, and this specific scenario is not clearly addressed (that I can find at least).

Our physician performed a surgery in the OR on a patient that was admitted (inpatient) a couple of days prior to the procedure, and was discharged a couple days later.
Our physician believes that since this procedure did not happen bedside, the place of service should be 22 (outpatient) because it happened in the OR. However, since the patient was an inpatient during the time, I feel this should be billed as 21 (inpatient).

All the details I'm finding regarding inpatient/outpatient POS suggests that if the patient is admitted, no matter what service is provided, the POS should be 21. But the specifics I'm finding only refer to observation coding, not surgical. 

Can anyone shed some light on this?

Any help is much appreciated!

Michele

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Re: Place of service for surgery....inpatient vs outpatient
« Reply #1 on: November 02, 2015, 11:29:13 AM »


All the details I'm finding regarding inpatient/outpatient POS suggests that if the patient is admitted, no matter what service is provided, the POS should be 21. But the specifics I'm finding only refer to observation coding, not surgical. 



Based only on the information given it sounds as if the POS should be 21.  The patient was inpatient for 4-5 days, and the procedure was performed during that time frame.  However, as a biller, if the provider instructs me to bill using specific information and I do not have access to the patient's chart/etc, I do bill as they instruct.  I will discuss it with them but if they want it done a certain way (and it's not anything fraudulent or not supported by documentation) then I do it the way they request.  I am not a certified coder and I am not reviewing the chart.

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footthebill

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Re: Place of service for surgery....inpatient vs outpatient
« Reply #2 on: November 02, 2015, 12:18:25 PM »
The thing is we already billed it w/ POS 22 and the claim was denied for wrong POS. We're discussing whether we change the POS to 21 or appeal the case.

dekenn

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Re: Place of service for surgery....inpatient vs outpatient
« Reply #3 on: November 02, 2015, 01:35:24 PM »
We had a surgery denied for place of service outpatient because the patient was admitted immediately following the surgery. The insurance company considered the patient inpatient because he was admitted. We resubmitted with inpatient place of service and it was paid. I think if the patient is actually admitted to the facility that the procedure was performed at, they are considered inpatient. The OR is still part of the hospital, but the patient didn't come to the hospital and leave the same day, which would be outpatient.

Michele

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Re: Place of service for surgery....inpatient vs outpatient
« Reply #4 on: November 02, 2015, 07:22:01 PM »
You haven't mentioned what surgery was done but it may be a surgery that requires an inpatient stay and therefore they are denying due to the POS 22.
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kristin

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Re: Place of service for surgery....inpatient vs outpatient
« Reply #5 on: November 03, 2015, 07:34:49 PM »
Just to add...if the patient is IP status when surgery is performed, regardless of whether the surgery is done BS or the patient is taken to the OR, the POS is 21. You are correct in thinking the POS should have been 21, and not 22. I would resubmit the claim with POS 21, and be sure to include the date the patient was hospitalized on the claim.


footthebill

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Re: Place of service for surgery....inpatient vs outpatient
« Reply #6 on: November 04, 2015, 09:02:28 AM »
thanks for the advice all, I had a feeling 21 was the correct POS, but hearing from others helps a lot