Medical Billing Denials – Matching Your Place of Service

Avoiding Medical Billing Denials – Matching Your Place of Service

Place of service codes are very important when performing medical billing. The place of service code will determine whether or not your practice is paid for services rendered. There are several different current procedural terminology medical billing codes that bring about confusion when choosing a place of service code.

Many times when billing for home services, medical providers get confused as to which place of service code to use. The only time the actual place of service “home” should be used is in a patient’s apartment, house, etc. In this case you would use place of service code 12 for medical billing.

Medical providers begin getting confused when a residential treatment center, or custodial care center is the place for the billable service. These places should not get place of service code 12 because they are not considered the “home”. They would get POS code 55 for residential substance abuse facility or POS 33 for custodial care facility.

Other billing confusions come when medical providers try to decide on what place of service code to use for a skilled nursing facility or a psychiatric ward. These cases are fairly simple. Again, the POS code 12 would not be used since this is reserved only for the patient’s actual house, apartment, etc. A skilled nursing facility has it’s own Place of service code: 32. The Psychiatric ward has it’s own place of service code as well. It is 56.

Matching correct place of service codes to the corresponding current procedural terminology codes is crucial when doing medical billing. If these codes do not match, they will be denied. To avoid the denial it should be a medical billing priority to check and double check all claims before they submitted. If your company uses an outside medical billing firm, they will do this for you. In medical billing, matching POS codes with CPT codes is crucial for reimbursement.

View all Articles by: Melissa Clark, CCS-P