Place of Service 21
Place of Service 21 in Medical Billing:
Place of Service 21 is also named as POS 21 in Medical billing. Place of service 21 is a two digit numeric code and used to identify the services rendered in “Inpatient Hospital”.
POS 21 Description (Inpatient Hospital):
POS 21 is indicated when a facility, other than psychiatric, which primarily delivers diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation facilities by, or under, the supervision of doctors to patients admitted for a variety of medical situations.
What if the Place of service 21 reported is invalid with procedure code billed?
Let us see with an example:
If an Evaluation and Management service (Office or other outpatient visit) is reported with place of service 21, the claim may be denied as “Incorrect Place of service codes, resubmit the claim with a correct place of service” or may be denied as “Invalid Place of service with the procedure code submitted”.
Because Place of service 21 is inpatient Hospital and is not compatible with the Evaluation and Management procedure code’s (Office or other outpatient visit). So we need to be very careful in selecting the correct place of service code, when submitting the claims in order to avoid the denials of claims from the insurance companies.
Rules to report Place of Service when patient is registered inpatient:
When services provided by physician/provider to a patient who is a registered inpatient should be reported with POS 21 (or other appropriate inpatient POS code (31, 51 or 61)), regardless of where the services were provided (face to face encounter).
It means when the service provided by physician/practitioner and patient is a registered inpatient, then the service should be reported with any one of the appropriate place of service listed below.
- Place of service 21, if patient registered in “Inpatient hospital”
- Place of service 31, if patient registered in “Skilled Nursing Facility”.
- Place of service 51, if patient registered in “Psychiatric Inpatient Facility”.
- Place of service 61, if patient registered in “Comprehensive Inpatient Rehabilitation Facility”.
Since the payment is made as per the Physician fee schedule (PFS) at the facility rate.
Assume patient transported to an office setting and performed an Evaluation and Management service from the physician, wherein the patient is registered as inpatient and are in an “Inpatient Hospital”.
In this case if the provider reports an outpatient Evaluation and Management service claim with place of service 11, claim will be denied stating “It is not reimbursed separately, when the patient is inpatient”.
So as per the above rule stated, we need to report the claim with place of service 21 (Inpatient Hospital), even though the office visit was in the office setting in order to reimburse physician service.
After reporting the place of service 21, some carrier’s may deny the claim. In that case we need to appeal the claim as per the above rule specified.