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Cataract Post-Op Place of Service

Jody Posted Fri 13th of February, 2015 12:23:22 PM

Recently, our practice has experienced an issue with one insurance company (a Medicare Advantage payer) recouping cataract post-op payments. The reason provided is that the place of service is incorrect. We always bill our post-ops with POS 11 and have had no problems. The service is taking place in our office, so this seems appropriate. I have searched for CMS documentation that addresses place of service for post-ops, but have been unable to locate anything useful. Am I correct in billing the post-op with POS 11? Are there any documents that I may be able to submit with an appeal that may help our argument? Any help is appreciated.

SuperCoder Answered Mon 16th of February, 2015 02:56:43 AM

Yes, you should submit the letter of explanation and supporting medical records indicating that post op care was provided in subsequent office visits. Thanks !!

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