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Place of Service for Pathologist

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tomtom2:
If you are a hospital based pathologist (you never leave the hospital) and a specimen is sent to you from a doctors office. What is the correct place of service the pathologist should report? 11-doctors office or 22-outpatient hospital? Keep in mind we are not a 81-independent lab and can not bill as such.

Thanks,

Michele:
I haven't personally come across this before but I did a little research.  The research points to the place of service should be the place the specimen was obtained, so in your example, 11 for office.

If anyone has any other info on these, please comment.

Thanks
Michele

tomtom2:
I've been researching this for over a month now and see why 11 for office would seen to been correct. But a handful of codes the pathologist bills for get higher payment for the office POS. Because they assume in your office you have additional expenses (rent, equipment,....), Rather than a facitily POS were the facility itself gets separate payment. I don't want to recieve any overpayments, but I want to bill the right POS.

Michele:
What I would recommend is calling one of the provider reps for a larger insurance carrier in your area and ask them how they want it billed.  That should clear it up, and they usually will be able to explain their reasoning to you.  We have done this in the past on similar situations and it has helped tremendously.  Most insurance carriers use the same guidelines for situations like this so picking one of the larger ones is usually good.

Let us know what you find out.

Thanks
Michele

tomtom2:
Florida Medicaid informed me that correct POS should be 22 outpatient.

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