Wiki Help with POS and E/M section

[kredd]

Small town hospital that has an attached OP clinic as well as an attached office visit clinic that this physician works at.

Scenario 1: Patient is an IP at the hospital. They wheeled the patient down to the physicians office so the physician could see the patient (physician didn't want to leave his office and since the hospital is right down the hall they brought the patient to him). The physician did x-rays in his office (he owns the equipment and does the interpretation) and he dictated the progress note in the hospital chart. This is basically a subsequent IP visit except they brought the patient to the physician, instead of the physician going to the patient.

Scenario 2: Pateint is an IP at the hospital. They wheeled the patient down to the OP clinic and the physician saw the patient and dictated a progress note in the hospital chart.

Does the location of the visit matter in these situations or would they just bill the 9923x with a POS 21 even though the actual visit took place at a POS 11 and POS 22? What about the xrays?

Any help on this would be greatly appreciated.

 

[Pam Warren]

Ok, for scenario #1, I have a question. Is the physician in a hospital-owned practice, where the office setting would be considered outpatient hospital...in other words, do you bill provider-based? Or, does the physician pay rent to the hosptial for his own private office? In the first case, bill POS 22. If he pays rent, bill POS 11, because technically, the patient has "left" the hospital to go to into the private office. The doc still has to be paid py the payer based on his office's physical setting; it wouldn't change to outpatient hospital just because of the patient's status.

For scenario #2, because the patient remains in a hospital setting when he leaves his bed to go to another hosptial department, the POS would continue to be 21, because he's still admitted and still physically in a "hospital" department. In this case, patient status determines POS.

I've clarified this with CMS recently, because we have had similar situations. Good question! Pam