Wiki Place of service Office vs Facility

[MelGib310]

I work for orthopedic surgeons and do physician based billing. One of our physicians wants to begin performing the knee meniscectomy procedure in the office rather than at the surgery center. Reason being, he has been performing diagnostic knee arthroscopies in the office using the Mi-Eye micro invasive visualization scope with great success for about 2 years. This procedure allows the physician to obtain real-time video imaging similar to an MRI. Per his research he states the meniscectomy can be done without anesthesia, using only a local. According to what I've read this is true and wouldn't have a negative bearing regarding the procedure itself. My question is regarding the reimbursement. Is this procedure (29881 and/or 29880) payable only in an out-patient surgical setting? In short, are the CPT codes payable in place of service 11 or are there restrictions? I’ve looked everywhere for a simple “list” of sorts to tell me if a code is payable at a particular POS and unfortunately I've not been able to locate anything. Any information you could provide is greatly appreciated.

 

[gonzalesl2010]

Place of Service

This most likely will be dependent upon the insurance company.

 

[mhstrauss]

I work for orthopedic surgeons and do physician based billing. One of our physicians wants to begin performing the knee meniscectomy procedure in the office rather than at the surgery center. Reason being, he has been performing diagnostic knee arthroscopies in the office using the Mi-Eye micro invasive visualization scope with great success for about 2 years. This procedure allows the physician to obtain real-time video imaging similar to an MRI. Per his research he states the meniscectomy can be done without anesthesia, using only a local. According to what I've read this is true and wouldn't have a negative bearing regarding the procedure itself. My question is regarding the reimbursement. Is this procedure (29881 and/or 29880) payable only in an out-patient surgical setting? In short, are the CPT codes payable in place of service 11 or are there restrictions? I’ve looked everywhere for a simple “list” of sorts to tell me if a code is payable at a particular POS and unfortunately I've not been able to locate anything. Any information you could provide is greatly appreciated.

On the Medicare fee schedule, there are no separate facility vs nonfacility fees for these codes the way there are for other codes that are often performed in an office setting. To me, that means CMS expects them to be performed in a facility setting. I"m not familiar with these procedures, strictly going off of that indicator on the CMS fees.

HTH some.