# POS: 49 Billing



## Jennifer Moore (Sep 3, 2013)

Can anyone please help me? I am new to the POS: 49 and POS: 11 billing so the coding of this is not quite clear. How would I code the following OP report for the surgery center not the provider

Summary of the procedure: An informed consent was obtained and the patient was taken in the fluoroscopy suite where she was placed in a prone position and cervical spine was prepped and draped in a usual sterile fashion. C5-C6 was identified. Head of the camera was rotated to open up the intravertebral space.

At this point skin infiltration with lidocaine 1% was given and 20-gauge Tuohy needle was introduced by loss of resistance technique in the epidural space. Injection of Omni Paque 180 in a volume of 3 cc indicted nice epidurogram that filled up the nerve root from C3 through C6 on both sides. The patient was injected with Marcaine 0.125% with Depo Medrol 40mg in a volume of 6 cc after negative test dose and negative aspiration for CSF and blood. Injection was done in increments with several minutes. The patient tolerated the procedure very well. The needle was pulled out.
The patient tolerated the procedure well without complications. The patient was then transferred to the recovery room for further observation and monitoring. Vital signs remained stable pre, post, and during the procedure. After observation in the monitoring room, the patient was allowed to sit, stand, and walk. At the time of discharge, the patient was alert and oriented.

 This is the way they are currently coding it:
62310 TC
77003 TC
A4550
99217 -25
Q9966 40units 
Thanks for any help anyone can give me.


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## capricew (Sep 3, 2013)

Jennifer Moore said:


> Can anyone please help me? I am new to the POS: 49 and POS: 11 billing so the coding of this is not quite clear. How would I code the following OP report for the surgery center not the provider
> 
> Summary of the procedure: An informed consent was obtained and the patient was taken in the fluoroscopy suite where she was placed in a prone position and cervical spine was prepped and draped in a usual sterile fashion. C5-C6 was identified. Head of the camera was rotated to open up the intravertebral space.
> 
> ...



the only codes you can report for the asc are:
62310
77003-tc 

you cannot report the surgical tray, the contrast or the E/M visit as they are inclusive to the procedure performed.  Unbundling them intentionally can be considered fraud.  (Not that your facility is doing so)  Also, the POS code for an ASC is 24.  I am not sure why POS 11 or 49 would be in question for an ASC.  (unless i am reading your question wrong, which is entirely possible)

Hope this helps.....


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## Jennifer Moore (Sep 4, 2013)

Thanks for the help to better explain we are a Independent clinic, not an ASC yet so we have to bill with POS 49.


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## capricew (Sep 5, 2013)

Sorry for the confusion!  i saw that you mentioned "surgery center" and went with that.

If you are an established independent clinic i would think that you would follow the same rules as if the doctor did the service in his office since you do not have an ASC certification.
If this is the case, then you would only bill for the doctor and leave the POS as 49.  A separate bill for the surgical portion is not necessary.  Because the POS is 49, there is a site of service differential (or increased payment) to the doctor for doing the procedure in his clinic and not using a licensed surgery center.  

The codes are the same but you get to bill for any drugs used and would report 99070 for the surgical tray or supplies that were out of the ordinary for a physician to provide.

Again, sorry for the confusion


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