Wiki Outpt Facility coding of procedure

[elainerouse]

My provider goes to a rural town hospital. The hospital provides the staff, the clinic and scheduling. We do not pay rent. We do bring one staff person.

We bring scopes with us. (ENT practice)

While we code our E&M codes with a POS 22 (outpt facility), we use a POS 11 for procedures performed with scopes, ex. 31237 or 31231 or 31575.

Our reasoning: the reimbursement for a facility is much lower. We feel, since we own the equipment, we should get the higher reimbursment rate.

For the past 25 years, we have billed this way. However, six months ago, we received notice of incorrect payment. BCBS of IA is stating this should have been billed as a POS 22.

I have talked to a BCBS of IA representative who states she understands and will see what she can do, however, since then, we have received a request for a separate service.

Any thoughts? I can't find a definitive statement to support either side.

 

[mitchellde]

Sorry even though you bring your own scopes all other expenses are incurred by the facility. The physical plant costs ( you do not pay rent but they do), the utilities, and staffing ( someone had to check the patient in and do vitals and get the room set up). Place of Service is always 22 for services provided in the outpatient setting .

 

[elainerouse]

out patient facility coding.

Boo, not the answer I was looking for. Just kidding.

Thank you for your help!