Wiki E/M billing when in patient

[kstephens]

We have a situation where patients are in an inpatient rehab facility. They are transported to our office for pain pump refills. We were told we could bill Medicare for the physician services and we are to bill the facility for the meds. We filed the office visit (99213 with place of service 11) to Medicare and they denied stating "not paid separately when the patient is inpatient". The facility is telling us we should put the place of service as a 61(comprehensive inpatient rehab facility) even though the office visit was in the office setting (pos 11). Our office has never heard this before. Does anyone have experience billing for the office visit when the patient is inpatient?

 

[CodingKing]

Place of service code needs to match the patient status. 21 for inpatient, 31 for SNF, 61 for inpatient rehabilitation facility. Its because inpatient is a status versus a specific location.

This MLN document may be helpful

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/MM7631.pdf

Special Considerations for Services Furnished to Registered Inpatients

When a physician/practitioner furnishes services to a registered inpatient, payment ismade under the PFS at the facility rate. To that end, a physician/practitioner/supplier furnishing services to a patient who is a registered inpatient, will, at a minimum, report the inpatient hospital POS code 21 irrespective of the setting where the patient actually receives the face-to-face encounter. In other words, reporting the inpatient hospital POS code 21 is a minimum requirement for purposes of triggering the facility payment under the PFS when services are provided to a registered inpatient. If the physician/practitioner is aware of the exact setting the beneficiary is a registered inpatient, the appropriate inpatient POS code may be reported consistent with the code list annotated in this section (instead ofPOS 21). For example, a physician/practitioner may use POS 31, for a patient in a SNF receiving inpatient skilled nursing care, POS 51, for a patient registered in a Psychiatric Inpatient Facility, and POS 61 for patients registered in a Comprehensive Inpatient Rehabilitation Facility.