Wiki Place of service codes

Create Wiki
C

chembree

Guru
Messages
242
Location
Rockmart, GA
Best answers
0
I need help understanding the fee schedule and place of service codes.

We bill for a Clinic and our doctors perform simple procedures there such as biopsies. We do not own the building, provide the techs, or equipment so we bill this as location 11.

next...

We have recently started performing vein procedures from our office, where we do own the building, we do provide the techs, and medical supplies and equipment. Should this also be billed as location 11?


I am just wondering because if the location triggers the payment we should be paid extra in our office... right? I know the kit for this procedure is pricey so there would need to be some advantage to providing it... right?
 
la_0922 said:
Are they performing the biopsies at an ambulatory center or at an actual office?
Click to expand...

The biopsies are at an actual office. I am confused on if we should get paid more for providing everything in our office.

(we are also an office - although we just started seeing patients her so this is new to us.)
 
From my understanding you are coding the POS correct, however if you dont own techs/equipment etc just make sure the applicable 26/tc modifier (if any) is needed and applied. Medicare will pay more for Facility pricing and usually the POS 11 will fall under the OPPS Cap amount -- we perform certain procedures in our office that will be paid under the Fee schedule because of the OPPS Cap... from CMS website
"The limitation of the physician fee schedule amount to the level of the OPPS payment amount applies to the TC portion when the global service is billed, and when the TC portion is billed alone. To determine if OPPS payment applies to the TC of diagnostic imaging services, contractors shall compare the physician fee schedule amount to the OPPS amount. If the lowest amount is the OPPS amount, contractors shall mark their disclosure reports as being capped at the OPPS payment amount."
you will have to check the fee schedule for these indicators.

Hope this helps
Louise
 
I appreciate your help with this and you taking the time to explain things to me. I am still a little confused as to what is the benefit of us performing the procedure ourselves and using our supplies (we are performing venous ablations) rather than performing it at a facility that will provide the supplies? I know the kit for the procedure cost hundreds of dollars and I have been told not to bill for it because it is included in the cost of the procedure.

Again thank you for your time.:)
 
well if the code is or can be broken down by 26 modifier or TC(technical component) modifier, if your clinic performs the procedure, then you are able to bill the Global component and capture both the 26 and TC part. However if you are at another clinic that is not affiliated with your practice, then they can capture the TC and you can only bill the 26modifier which would be less.

For example:
Abdominal Ultrasound Global component = $ 128.54 <-- when you own equipment etc
" " TC component = $90.57 <-- the hosp/ambulator center etc
" " 26 modifier = $37.97 <-- the physician involvement

If code cannot be broken down, and you can bill for supplies seperately then you have the option for billing HCPCs codes for those which would be a benefit if your practice owned said supplies (catheters etc)

Hope this helps :)
Louise
 
la_0922 said:
well if the code is or can be broken down by 26 modifier or TC(technical component) modifier, if your clinic performs the procedure, then you are able to bill the Global component and capture both the 26 and TC part. However if you are at another clinic that is not affiliated with your practice, then they can capture the TC and you can only bill the 26modifier which would be less.

For example:
Abdominal Ultrasound Global component = $ 128.54 <-- when you own equipment etc
" " TC component = $90.57 <-- the hosp/ambulator center etc
" " 26 modifier = $37.97 <-- the physician involvement

If code cannot be broken down, and you can bill for supplies seperately then you have the option for billing HCPCs codes for those which would be a benefit if your practice owned said supplies (catheters etc)

Hope this helps :)
Louise
Click to expand...




Thanks so much Louise! You did really help me!
 
You must log in or register to reply here.
Top