May 1, 2014
We are in an orthopaedic practice that is attached to the hospital. On occasion our physicians will have a stable patient transported to the office for appropriate medical evaluation. We are seeing denials for invalid place of service and we are not sure what is wrong. We have submitted the claim with POS 11 for our office.
Your question is timely, as it appears there has been a significant increase in denials being received in various parts of the country. The correct place of service (POS) for this visit is the inpatient hospital, not POS 11 since the patient is in a Part A covered facility. We have also seen similar denials when patients are in skilled nursing facilities or inpatient rehabilitation facilities. If you have specific questions about place of service, or have not yet seen such denials, KZA recommends you contact your local carrier and discuss how claims should be submitted if the patient is in any type of Part A stay and seen in your office during the Part A covered stay. Orthopaedic coders and billing staff are very well versed in how to report X-Rays when a patient is in a Part A covered SNF; this POS issue adds additional complexity to claims submission.