Wiki Modifier for patient not in SNF at time of service

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E. Knowlton

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Can anyone tell me - A Medicare patient was seen by our doc at a wound clinic and had a visit and wound debridement. He came from a rehabilitation center but was not in the SNF of this center at the time of service. Medicare is denying the claim saying that I have to bill the SNF but they won't pay because they say he was not in SNF at the time.
I was told that I should be sending this claim in with a modifier. Is there a modifier that states a patient was not in a SNF at time of service?
 
The POS guideline states you use the POS of where the patient was registered at the time the service is rendered, regardless of the actual place where the procedure is performed. So the POS for this scenario would be the snf and in all likelihood you will be billing the snf and not Medicare.
 
I also code for a wound center and have had the problem if patient is not in a SNF, but rehab. You just need to send a "redetermination" (first level appeal) to Medicare with chart notes and state that "patient is not in SNF". This will force a person to verify that the patient was in rehab and not SNF. If that fails, send to second level "reconsideration" and it should get paid. It has worked for us.

Elaine
 
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