tci ED Coding & Reimbursement Alert - 2003 Issue 10

You Be The Coder: Place of Service and 36430

Question: I billed 36430-59 with place of service 23 (Emergency room - hospital). Medicare denied payment for the claim because of the place of service, so I changed it to 22 (Outpatient hospital). Again they rejected the claim, so I contacted them and asked, "What if the doctor performed the procedure?" The representative instructed me to submit a report, and when I did, they denied the claim a third time due to "inappropriate place of service." Is there a way to bill this and get reimbursed?     Idaho SubscriberAnswer: Unfortunately, CMS doesn't pay...

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