# Place of service 21 or 23?



## Tonyj (Aug 4, 2014)

I've posted this previously but have not gotten a response. I'm hoping someone can help me with this question. 

Patient was sent to the ED from clinic 7/16. Physicians dictates admit note 7/17 but the patient is never moved out of the ED. Physician dictates discharge note 7/18. What place of service should I use for physician billing. 21 inpatient; 23 ED??


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## angie1027 (Aug 4, 2014)

You can bill an ED visit, 99282- 99284 depending on los provided for the consultation (should not be an admit unless the pt is admitted). You can use 23 for consult and d/c if the pt never left the ED.

If the patient was put in an observation status, you can bill ED-23 for the initial visit and 22-outpatient for the discharge. Usually the hospital will class this as an observation stay because of the duration. For discharge from observation, the cpt is 99217. You may want to check with the hospital to see how they classed the visit. Hope this helps.


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## TeddiBell (Aug 17, 2014)

my understanding is that if they are never actually admitted, they are not an impatient. they can stay in observation on the ED for more than one day, so even overnight does not make them inpatient


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## mitchellde (Aug 17, 2014)

If the provider writes an admit order then the patient is an inpatient from that point on.  It does not matter the patient's exact location since any bed can be an inpatient status.  During times of extremely high census we actually did have patients in the hall but they were inpYients.


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## Tonyj (Aug 18, 2014)

mitchellde said:


> If the provider writes an admit order then the patient is an inpatient from that point on.  It does not matter the patient's exact location since any bed can be an inpatient status.  During times of extremely high census we actually did have patients in the hall but they were inpYients.



Thanks Debra. I was considering the same. I'll use the 21 POS.


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## josiew3 (Sep 3, 2014)

In order to code as POS 21 you need to have an admit order for inpatient status from physician.  You would also need an admit order for observation status.  If you have neither of those the patient's status would remain as ER.


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## cherri.mills@mwhc.com (Jan 9, 2019)

*ED with a delivery of baby*

I have a billing issue where the billing dept is arguing that if the patient doesn't go home the ED code 99282-84 uses POS 22.  Then the delivery is POS 21.  I am arguing if the dr write the order and they are in labor they are classified as In pt even if they go up to the labor floor or stay in the ED dept.  There are never observation unless the Dr isn't sure to admit or not, so writes an order to observe and then either admits or sends home.  Is there anywhere this is hard copy so I can "prove" it to them? Insurance has denied claims so they want our IT dept to change the POS for 99282-85 to be POS 22 and I am disagreeing.  Any help with this? sounds like above threads agree with me.  Apples to Apples is how I was taught.

thank you


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