Wiki Patient from a rehab hospital brought in for RFC, denied by Medicare

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JessBojan

JessBojan

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Madison Heights, MI
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I was wondering if anyone could give me some guidance/advice on how to go about billing this visit out. The patient is in a rehabilitation hospital but was brought in to have her nails trimmed (he billed for an office visit), which is not related to her treatment at the hospital. The dx codes are 110.1 and 729.5. Medicare is denying due to M2 : Not paid separately when the patient is an inpatient. & CO-58 : Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.

Any help or guidance on how to find out would be greatly appreciated!!
:confused: :confused:

Jessica Bojan CPC, CPB
jbojan@traknetrcm.com
 
You'd code POS 11, but you may want to check to see if the RFC is covered under consolidated billing rules. It may be that that RF care can't be provided outside of the admission in the rehab, and that the rehab is expected to provide that care. If so, Medicare has already paid the rehab for that service, and won't also pay you.
 
Pam
You need to check the Medicare instructions for this. It has been posted in other threads as well. You use the POS of where the patient is registered regardless of the setting of where the service takes place
 
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