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Medical Coding News Archives

Reporting Services Provided at the Patient’s Home

September 2, 2010:
A recent Medicare transmittal clarifies that when the place of service code is 12, Home, the patient’s home address must be reported.

Medicare bases the reimbursement on the site of service. With the adoption of the 5010 version of the 837p, the reporting of the place of service (POS) code must coordinate with the address where the service was rendered. In the past there was an exception for POS 12, Home, which is used for services provided in the patient’s home. However, many have been reporting the provider’s address and ZIP code rather than the patient’s actual address and ZIP code.

Transmittal CR6947 states that beginning January 1, 2011, when POS 12 is reported on either the electronic 5010 version of the 837p or the paper CMS-1500 the patient’s home address and ZIP code must be reported as the physical location of the service. This is loop 2310D or 2010AA for the 837p and field 32 for the CMS-1500. Only one place of service may be reported for each CMS-1500 form submitted.

Services provided in more than one location must be billed separately. Medicare will return claims with more than one POS with claims adjustment reason code (CARC) 16, Claim/service lacks information which is needed for adjudication. The claim will also have at least one remittance advice remark code (RARC). The most likely RARC will be one of the following:

M77, Missing/incomplete/invalid place of service MA130, Your claim contains incomplete and/or invalid information, no appeals rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information MA114, Missing/incomplete/invalid information on where the services where furnished

Note that this change is effective only for the 5010 version of the 837p and CMS-1500. This does not apply to the 4010A1 version of the 837p.

Nannette Orme, CPC, CCS-P, CPMA, CEMC
Clinical/Technical Editor


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