General

General Question for the Week of April 13, 2020

General Compliance Question of the Week

Question:

We have an office that is a provider-based entity owned by the hospital. Diagnostic exams are billed as hospital outpatient exams, but how do we bill the professional component? What place of service (POS) is used?

Answer:

The professional component place of service for diagnostic exams is reported as the place of service where the exam took place. In your case, that would be POS code 19 for off-campus outpatient hospital or 22 for an on-campus outpatient hospital. The address for the actual location where the interpreting physician was sitting would be reported in block 32 of the CMS 1500 (or electronic equivalent) claim form. Modifier 26 would be added to the appropriate CPT® code for the interpretation only.

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