Neurology & Pain Management Coding Alert

Question: I code for a neurologist who usually sees patients in his office. But one week out of the month, he goes to the hospital to read carotid test results. Should I report POS 21 or 22 for these patients?

New York Subscriber

Answer: The patient's location determines your place-of-service (POS) code, according to HCPCS manual Appendix 6.

POS 21 (A facility, other than psychiatric, which primarily provides diagnostic, therapeutic [both surgical and nonsurgical], and rehabilitation services by, or under, the supervision of physicians to patients admitted for a variety of medical conditions) is appropriate if the patient is a hospital inpatient.

Use POS 22 (A portion of a hospital that provides diagnostic, therapeutic [both surgical and nonsurgical], and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization) if the patient is present in a hospital but on an outpatient basis. In either case, you should code your neurologist's claim based on the patient's actual location and status.

Remember: Code the precise service your neurologist performs while at the hospital. You should append modifier 26 (Professional component) to indicate that the neurologist's services included only the professional component of diagnostic studies, such as interpreting carotid test results (93886-93893, Transcranial Doppler study of the intracranial arteries; complete study -). The facility will bill the technical component (including providing staff and equipment).