ladams67601
Guest
Our ophthalmologists are independent practitioners who lease office space in a building connected to the hospital. When an ophthalmological consult is requested, the physicians often insist the patient be brought to their office because the hospital does not have the equipment necessary for an ophthalmological exam. Until 2008, the Kansas carrier instructed us to bill POS 11 (physician office) since the patient is no longer in the hospital. WPS became the Kansas carrier in 2008 and takes the position that the patient remains an inpatient even if services are performed in the physician's office. WPS cites the Medicare Claims Processing Manual (MCPM), Chapter 26, section 10.4, Item 24B, a section that describes the use of each box on the CMS 1500 form. My question: Do other carriers also interpret the MCPM to prohibit billing POS 11 during an inpatient stay even though the professional services are rendered in the physician's office?