Wiki Pos

[joypogo@yahoo.com]

At our behavioral health outpatient facility the supervising psychiatrist stays in the building and the counselor sees the patient at school. The claim is being denied because of place of service. The payor no longer accepts code 3 for school and wants us to switch it to 11 to get the claim paid. Even though the POS is not in the office. Legally, just appeal the claim? or switch POS?

 

[mitchellde]

You cannot change the POS also if the psychiatrist was not present with the counselor the you must use the counselor a NPI in field24j as the rendering provider. If the counselor does not have an NPI the you have no way to bill for the encounter

 

[joypogo@yahoo.com]

Ok, the counselor does not have an NPI. This is my second week working in behavioral health. It didn't sound correct to change it. Thank you for your help.

 

[mitchellde]

If the counselor had no NPI and the psychiatrist did not leave the office the you cannot charge for the encounter. The counselor can see patients under direct supervision of the psychiatrist which means for any visits other than in the office the provider must be physically within reach. So it sounds like this encounter cannot be billed.