Gastroenterology Coding Alert

Question: Our physician was called to the ER to see a patient for dysphagia. He assessed the patient and found a food bolus. Physician performed removal of foreign body (43247). This was neither a consult nor was it an admit. The charge posted for the physician was an ER CPT® with 25 modifier but should the POS be outpatient because procedure not done in the ER or should the POS be specifically ER POS?

West Virginia Subscriber

Answer: For all the services provided, the “place of service (POS)” should match the actual setting in which the patient received the face-to-face service. However, there are two exceptions to this “place of service” guideline. This requirement does not apply when any service is provided to patients who are registered as “inpatient” or as “outpatient” in a hospital setting.

When a patient is registered as “outpatient,” you will have to report place of service as “outpatient” or “POS 22” irrespective of where the patient actually received the service. This requirement will help trigger facility payment to the patient’s services.

In case your clinician knows the exact setting in which the patient is registered as a hospital outpatient, you can actually report this place of service code instead of POS 22. As in your case scenario, if the patient that your clinician saw is a patient registered to your “emergency room,” then you can list the place of service as “POS 23” instead of “POS 22.”

For more details on correctly reporting the POS codes for “inpatients” or “outpatients,” check this link at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2679CP.pdf.