Place of Service 23 in Medical Billing:
Place of Service 23 is also called as POS 23 in medical billing. If the procedure performed in “Emergency room hospital”, then the claim is indicated with place of service 23.
POS 23 Description – Emergency room hospital:
POS 23 is indicated, when a portion of a hospital where emergency diagnosis and treatment of illness or injury is provided.
Frequently asked question on POS 23:
- What If Medical office visit service is denoted with place of service 23?
Answer: The claim may be denied as “Incorrect Place of service codes”. Place of service 23 is for an emergency room services and for medical office visit service the claim should be reported with the place of service 11 in order to process the claim correctly from the payers.
- Patient has seen in emergency department and has surgery (not admitted to the hospital). Would claim reported with place of service 23 for surgery, even though they were in emergency department?
Answer: If the service was performed bedside while patient was in emergency room then it should be reported with place of service 23.
If the patient was taken to the operating room or procedure room but not admitted as an inpatient, then we should report the claim with place of service 22(Outpatient hospital) as per the below rules. The payment for both the place of service is paid same at the facility rate.
- Patient was directed to emergency department from doctor’s office on 12/16/2019. Provider writes an admit order on 12/17/2019 and discharge letter on 12/18/2019, in this case which place of service code is used (Whether it is Place of service 23 or Place of service 21)?
Answer: In this example, patient is inpatient as the patient is admitted on 12/17/2019 as the physician writes an admit order. Here we need to use place of service 21(Inpatient Hospital) instead of place of service 23(Emergency room hospital).
- Can we use Observation code with Place of service 23?
Answer: No, we should not use observation codes with place of service 23.
The rules are as follows:
- When a physician/practitioner provides health care services to an outpatient of a hospital, reimbursement is made under the MPFS at the facility rate. Physicians/practitioners who provide health care services to a hospital outpatient, including in a hospital outpatient department (including in a provider- based department of that hospital) or under arrangement to a hospital will, at a minimum, report the outpatient hospital POS code 22 irrespective of the setting where the patient actually receives the face-to-face meeting. In other words, reporting the outpatient hospital POS code 22 is a minimum condition for purposes of triggering the facility payment amount under the PFS when services are delivered to a registered outpatient.
- If the physician/practitioner is aware of the particular setting the recipient is a registered hospital outpatient, the suitable outpatient facility POS code may be reported with the code list annotated in this section (instead of POS 22). For example, physicians/practitioners may use POS code 23 for services provided to a patient registered in the emergency room, POS 24 for patients registered in an ambulatory surgical center.