Place of Service 22 in Medical billing:
Place of Service 22 is also called as POS 22 in Medical Billing. Place of Service 22 is a two digit numeric code and used to identify the procedure performed in “On Campus – Outpatient Hospital”.
Effective from January 1, 2016, place of service 22 was introduced by CMS-Center for Medicare and Medicaid services for medical services rendered in outpatient settings outside of the main hospital campus. As this place of service 22 was executed, providers will need to distinguish whether their hospital place is considered “on campus” or “off campus” when billing their professional health care claims, because if the medical services performed on “Off campus” place of service 19 must be used.
CMS indicated the purpose of implementing the place of service 22 for professional healthcare claims is to accumulate data (Statistics) of “Off-Campus (POS 19)” v/s “On-campus (POS 22)” Outpatient Hospital.
First let us understand the description of “On Campus – Outpatient Hospital” to understand the usage Place of Service 22 on the HCFA Claim form.
Place of Service 22 Description (On Campus – Outpatient Hospital):
Hospital outpatient unit is considered “on-campus”, if it is less than 250 yards from the main hospital campus.
On Campus – Outpatient hospital is a portion from the hospital’s main campus that delivers medical services such as therapeutic (both surgical and non-surgical), diagnostic, and rehabilitation facilities to sick or injured individuals who do not necessitate hospitalization or institutionalization.
POS 22 vs 11
When selecting the place of service between the POS 22 vs 11 for professional claims, we must see the following two scenarios in order to choose correctly:
- If the hospital owns the space and employs the staff and all the expenses (Provider based department of the hospital), then we need to report with POS 22. In this case the reimbursement for the provider will be less as the hospital is the entity solely responsible for the overhead. The hospital will then submit a claim for the use of the facility.
- We report the claim with POS 11, when it is separately maintained physician office space in the hospital campus. Here we need to consider two things:
- Whether physician pays rent and reimburses the facility for staff out of their physician revenues.
- And next we need to see physician organization has a different and separate Tax ID than the hospital to submit their professional claims.
Conclusion: For better solution for the above scenarios (POS 22 vs 11), please check with health care providers to whom you are submitting the health care claims.
Frequently asked Questions:
- Provider rendered the healthcare services to patient initially in an emergency room and then patient was admitted to Emergency Treatment Unit for 24 hours Observation, for reporting observation codes what is the correct Place of Service code for physician billing?
Answer: We use outpatient place of service code, because observation codes is considered as outpatient hospital as patient has not admitted to hospital as Inpatient. Hence claim should be reported with either place of service 22(If it’s Hospital In-Campus) or place of service 19 (If it’s Hospital Off-Campus).