Wiki Appropriate POS for 52224

[alp.jeffrey]

I had an office bill 52224 with POS 11 and Medicare denied for incorrect POS. Is there somewhere I can find out the appropriate POS for procedures? I need to be able to show this office proof.

 

[Pam Warren]

The appropriate POS that you would report is where the service took place. I don't see anything that indicates that this procedure can't be done in the office setting, so there may be another issue in play here. Whatever you do, don't change the POS specifically to get payment, as that's a violation of the False Claims Act.

Now.....some Medicare advantage plans (United for example) have site of service guidance where they expect the service to be performed (such as at an ASC) and the won't pay if it's done in a different location. But that should have been investigated by your office in advance.

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/attachments/commercial/outpatient-surg-procedures-site-service-cpt-hcpcs-codes-ma.pdf

I've attached the link for the United MA plan document.

 

[alp.jeffrey]

I'd never change POS just to get a claim paid. No way. The only denial on it is POS denial. The UHC list is perfect if only there was one for traditional Medicare. I'm about 90% sure this procedure can't be billed POS 11 and I wanted to send the office a list of codes like the one from the link you sent. I'm a remote coder for that office so unfortunately I don't have much control over the investigations prior to services. I wish I did though. Thanks for the reply and that MRA list.