Pediatric Coding Alert

Question: Our patient went to an outpatient hospital for a test, but then our pediatrician interpreted the results in our office. Should I use the POS of where the doctor interpreted the test (office) or the outpatient hospital?

Codify Subscriber

Answer: Because the face-to-face portion of the service happened at the outpatient hospital, that’s the POS you should report. Choose between POS 19 (Off campus-outpatient hospital) and POS 22 (On campus-outpatient hospital) for the outpatient hospital POS.

Support: Although CPT^® doesn’t have a statement on this issue, Medicare does. Many private insurers follow Medicare rules when making theirs, so you can use the Medicare rules as a guideline. However, check with your payer to determine whether it has any insight into this issue which could trump Medicare rules.

In Medicare Claims Processing Manual, Chapter 12, Section 150, you’ll find a statement that “As a general policy, the POS code assigned by the physician/practitioner for the PC of a diagnostic service shall be the setting in which the beneficiary received the TC service.”

Medicare provides exceptions to the general policy. If the beneficiary is a hospital inpatient or outpatient, always report the inpatient or outpatient POS, regardless of the actual setting of the technical and professional components. If your private payer doesn’t follow Medicare rules, then get the insurer’s policy in writing and use that as your POS guidance.