Resolved Pathology Billing

[TeresaB_63837]

What POS we should bill if specimens was taken at ASC and was sent to our lab. As a physician owned lab, POS is typically the location where the specimens was collected.
Is POS 24 the appropriate place to bill. We got denial billing POS 11, we can't bill POS 81 because we are not an independent clinical laboratory. We are a physician owned laboratory. Thank you

 

[Lori]

What place of service (POS) do I use when reading a test from a remote location?

Answer: Yes 24 is for ASC

Effective April 1, 2013, CR 7631 establishes that for all services – with two exceptions – paid under the MFPS, the POS code to be used by the physician and other supplier will be assigned as the same setting in which the beneficiary received the face-to-face service. Because a face-to-face encounter with a physician/practitioner is required for nearly all services paid under the MPFS and anesthesia services, this rule will apply to the overwhelming majority of MPFS services. In cases where the face-to-face requirement is obviated such as those when a physician/practitioner provides the PC/interpretation of a diagnostic test, from a distant site, the POS code assigned by the physician/practitioner will be the setting in which the beneficiary received the TC of the service.

There are two exceptions to this face-to-face provision/rule in which the physician always uses the POS code where the beneficiary is receiving care as a hospital inpatient or an outpatient of a hospital, regardless of where the beneficiary encounters the face-to-face service. The correct POS code assignment will be for that setting in which the beneficiary is receiving inpatient or outpatient care from a hospital, including the inpatient hospital (POS code 21) or the outpatient hospital (POS code 19 or 22). The Medicare Claims Processing Manual already requires this for physician services (and for certain independent laboratory services) provided to beneficiaries in an inpatient hospital and CR 7631 clarifies this exception and extends it to beneficiaries in an outpatient hospital.

PLACE OF SERVICE CODES – Full list | Medicare Payment, Reimbursement, CPT code, ICD, Denial Guidelines

medicarepaymentandreimbursement.com

POS thread:

Resource - Place of Service

Place of Service Code Set Place of Service Codes for Professional Claims Database (updated September 2021) Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity where service(s) were rendered. Check with individual...

www.cco.community

Denials thread:

Resource - Denials

Review Reason Codes and Statements CMS contractors medically review some claims (and prior authorizations) to ensure that payment is billed (or authorization requested) only for services that meet all Medicare rules. If the review results in a denied/non-affirmed decision, the review contractor...

www.cco.community

 

[TeresaB_63837]

Thank you so much Lori! This information is very helpful

 

[MaxJ_73339]

What POS we should bill if specimens was taken at ASC and was sent to our lab. As a physician owned lab, POS is typically the location where the specimens was collected.
Is POS 24 the appropriate place to bill. We got denial billing POS 11, we can't bill POS 81 because we are not an independent clinical laboratory. We are a physician owned laboratory. Thank you

Do you guys have your own billing setup? How'd you managing it?