Place of Service 11 in Medical Billing:
Place of Service 11 also called as POS 11 in Medical Billing. When a patient meets a doctor in clinic it is called as an “Office Visit” and place of service 11 replicates the service was provided at an office.
POS 11 Description:
POS 11 is reported when a location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional regularly delivers health examinations, diagnosis, and treatment of disease or injury on an ambulatory basis.
What if Place of service 11 reported inappropriately?
Medicare makes payment to provider a higher amount for procedure rendered in their offices and billed with place of service11, than in an outpatient hospital (Place of service 22 or 23) or an ambulatory surgical center (Place of service 24). Therefore, we should come to conclusions that place of service plays an important aspect in the reimbursement.
So we should be careful while reporting the place of service codes to avoid program abuse.
Suppose assume minor surgical procedure that is actually performed to patient in hospital outpatient department, but when reporting the claim it’s reported with place of service 11. Here the reimbursement will be higher and it is inappropriate billing and may be viewed as program misuse, because the services performed in the hospital outpatient department and should be reported with place of service 22.
Frequently asked questions on Place of Service 11:
- POS 11 vs 22
Patient sees the separately maintained doctor office, and then patient goes to hospital outpatient infusion center to have chemo on the same day. If E/M codes performed by separately maintained doctor office billed with place of service 11 and chemo service performed by hospital outpatient infusion center reported with place of service 22, will the E/M service billed with place of service 11 reimbursed from the Medicare insurance?
Answer: Medicare will normally deny the E/M service on the same day as Chemo service performed, except if you documentation that supports that the patient was seen for reason unrelated to the chemo service. So we should appeal if you have supporting documentation.
Important note: We should not use a 25 modifier for E/M service as the chemo service was billed by hospital outpatient infusion center and they will not be billing for an E/M service when the patient is there for planned chemo service.
2. Do payers pay the procedures that are not approved to perform for office setting (place of service 11)?
Answer: No, they won’t pay those procedure’s which is not approved to be performed in an office setting.
For example: If you take CPT 24071(Excision of right forearm Lipoma) performed in an office setting (place of service 11), payers will be not reimburse the claim. Suppose, if you have performed this procedure in an office setting (place of service 11), provider must write of the entire amount.
3. How to choose the correct POS 11 vs 22?
Answer: If providers are separately maintained independent physician office then claim should be reported with place of service 11 and it cannot be reported with place of service 22.
If it’s a Provider based department of the hospital, then claim should be reported with place of service 22.
Claim should be reported with correct place of service as the reimbursement is different based on the place of service. Place of service 11 reimbursed higher when compared to place of service 22, so if you submit the claim with inappropriate place of service it’s a program abuse.