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Capsule Endoscopy

Tammy Posted Tue 24th of February, 2015 16:49:07 PM

We have a patient who is in the hospital on the Rehab floor. They want to bring her to our office long enough for us to do a capsule endoscopy (91110) then take her back to the rehab floor. I would bill the CE with a POS 11. Patient has MCARE. Will MCARE reject the claim because she was technically an in-patient during this time? We do not want to do the CE at the hospital because they would then receive reimbursement for the capsule and we receive payment only for the reading (we've been down that road before). Please respond ASAP.

SuperCoder Answered Tue 24th of February, 2015 23:09:17 PM

Thanks for your question. You are correct, Medicare will probably deny due to the place of service. Medicare will generally reimburse for the capsule if you are providing it in the inpatient setting if you submit documentation as well as send in an invoice indicating the cost of the capsule. You should also consider having the hospital supply the capsule so that your practice will not absorb the cost of the capsule. Hope this helps.

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