Oncology & Hematology Coding Alert

Question: I enjoyed the August article on hospice care but was confused by the explanation of place-of- service codes. Should I choose the code based on where the patient is admitted even if we see him in the doctor's office?


Georgia Subscriber
  

Answer: Excellent question--this is an important point to get the facts on.
 
For individuals who are admitted to a hospital, nursing home, etc., the patient status is the place of service. Result: If a patient admitted to a hospice facility (inpatient) goes to a freestanding center for an appointment, the place of service is 21 (Inpatient hospital). The freestanding center must then bill the facility for the technical services. (Best bet: Have a contract in place).

In other situations, when a patient isn't admitted to a facility, you should choose the place-of-service code based on where you see the patient. The HCPCS manual states that the place-of-service codes -should be used on professional claims to specify the entity where service[s] were rendered.- So if a patient is receiving hospice services at home and goes to a doctor's office, choose place-of-service code 11 (Office).

You can read the CMS hospice regulations at www.cms.hhs.gov/manuals/downloads/clm104c11.pdf.