Wiki Place of Service Denials Question

[katcoder]

A bariatric surgeon performs gastric bypass surgery and bills the claim with POS 21 (inpatient). While the patient was on the table, she was noted to have a ventral and hiatal hernia that needed to be repaired. The bariatric surgeon called in a general surgeon for the repair.

The general surgeon also bills their claim with POS 21 (inpatient). The general surgeon’s claim was denied because there was no preauthorization. But there would not have been a preauthorization because it was not known in advance; it was found out while the patient was on the table having bariatric surgery.

In this instance, should the general surgeon bill with POS 22 (outpatient) because it does not require an authorization and will be paid?

Any help on this is greatly appreciated!!

 

[mitchellde]

POS 21 is inpatient and 22 is outpatient . No you cannot chose the POS based on what pays, the PPS depends on the patient status. Since the patient was inpatient at the time of the procedure then all services must be billed with pos 21. Most plans allow for these types of surgeries as long as with is obtained within 24 hours. If that did not happen then it is possible that those procedures are not payable.

 

[Lori Julian]

Are you sure that your gastric bypass was inpatient? We schedule ours ambulatory and then the patient gets admitted from recovery.

 

[katcoder]

Our bypass surgeries are pre-authorized as inpatient.

Thank you both for your responses!

 

[mitchellde]

It may be that they are preauthed as inpatient , however it must be billed with the POS of where the patient is registered at the time the surgery is performed.

 

[katcoder]

Thank you Debra