General Question for the Week of May 23, 2016

General Compliance Question of the Week

Question:

In regard to assigning the mandatory modifier PO on hospital outpatient claims, can the same claim have both a HCPCS with the PO modifier and a HCPCS without the PO modifier? 

Answer:

As you say, reporting of this two-digit modifier began mandatory beginning on January 1, 2016. It must be reported with every code for outpatient hospital items and services furnished in an off-campus provider-based department (PBD) of a hospital.

In answer to your question, yes, a single hospital outpatient claim (type of bill 13X) could have a HCPCS code with the PO modifier and without the PO modifier such as when a patient is treated at an off-campus provider-based department and the on-campus hospital on the same day.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.