Is the CMS web site giving you the runaround? Bookmark this handy page of links and get straight to where you’re going.

I’ve just moved to a new suburban town and I get lost a lot. All the streets go in circles, and the strip malls all look the same. It reminds me of the CMS web site, where I get lost a lot too.

If you’re new to coding, don’t think the CMS web site confuses you just because you’re new. I’ve been getting lost in that big mess since CMS was HCFA.

Here’s good news, though. CMS has published a handy reference chart here, and we’ve collected the links we think will be most helpful to outpatient coders. Bookmark this page and click these links to get exactly where you’re going, with no more tears.

Decipher That Alphabet Soup with this Acronym Lookup

ABN Information Center

Information for ASCs

E/M Documentation Guidelines

E-prescribing guidance

All about HCPCS codes

ICD-10 Sneak Peek

MLN Matters Articles

CCI edit information

Physician Fee Schedule Lookup

CMS Physician Center

Transmittals

Come on: If you’re smart enough to go to the CMS website and emerge in one piece, you can pass your CPC exam! Learn more here.

When you go to the CPC® exam prep information posted on the AAPC web site, you’ll see that some questions cover ‘practice management.’ The AAPC wants certified coders to understand topics like the OIG Work Plan, ABNs, Medicare fraud & abuse rules, and place of service codes.

Today, in the first of My Coding Career’s series on preparing for the practice management questions, we tell you what’s up with Place of Service (POS) codes. Bonus: Correct POS coding can help you avoid denials and sail through audits in your coding job, even if you’re not studying for the exam.

POS codes are 2-digit codes that indicate where the service was provided — in the doctor’s office, inpatient hospital unit, hospice or skilled nursing facility, just to name a few examples. POS codes describe in numerical terms the classification of the information found in Box 32 (Name and Address of Facility) where services were rendered. You should place the POS code in Box 24B for each line item of the CMS-1500 form for Part B claims.

Study Tip: There are too many POS codes to list individually here. However, if you want to take a look at them, just go to this CMS page and download the ’POS Database’ on PDF.

‘Open Book Exam’ Tip #1: Don’t worry about memorizing each and every POS code. It’s most important to know the POS rules and why they’re so important. (We’ll get to that soon.) If you need to look up a POS code in the exam, go to the back of your HCPCS coding manual to find a list of them in ‘Appendix 6.’

‘Open Book Exam’ Tip #2: Most HCPCS manuals I’ve seen have no tabs, so it’s especially important to tab hotspots in your HCPCS book. So, put a tab on Appendix 6 that says ‘POS.’

So what’s the big deal about POS codes? First, HIPAA (which among other things requires standardized code sets) specifically requires Place of Service Codes. Second, carriers often need POS information to determine the acceptability of direct billing of Medicare, Medicaid and private insurance services performed by a given provider.

Translation: If you don’t know your POS codes, you could pull denials. Medicare uses processing edits that may prevent you from receiving reimbursement if you list an incorrect place of service. For example, you will not receive payment for initial hospital care (99221-99223) with a place of service of 11 (Office).

Worse, incorrect POS codes can attract audits. That’s because Medicare often pays physicians more for services in the office setting (where they incur more expense) than in facilities, so inappropriate use of POS 11 (Office) leads to Medicare shelling out more money that it should. Because incorrect POS codes can result in overpayments, the OIG says in its 2010 Work Plan that it’s on the lookout for claims that indicate ‘POS 11′ when the services were actually performed in ambulatory surgical centers (ASCs) or hospital outpatient departments. And if the OIG is looking to audit, you can trust the payers are too.

More POS Coding Tips

Don’t Assume Hospital Arrangement = POS 22: For professional component claims of diagnostic tests performed under arrangement with a hospital, choose the POS based on where the physician performs his portion of the service. For example, if a cardiologist interprets the test in a hospital, look to POS 22 (Outpatient hospital). But if he interprets the test in an office, you should choose POS 11.

Nursing Homes are Tricky: Confusion about the three nursing home place of service (POS) codes arises because a facility can have both skilled nursing and nonskilled nursing beds at the same time.

POS code 31 (Skilled nursing facility): Use this code when your physician treats a patient who is in a skilled bed at the time of service. This means the patient has a medical condition that requires skilled nursing care,  such as injections or ventilation. Medicare must authorize skilled nursing services and considers them a Medicare Part A expense.

POS code 32 (Nursing facility): Choose code 32 if the patient is not on Part A Medicare, but instead is on long-term care and is receiving medical, nursing or rehabilitative services.

POS code 33 (Custodial care facility): These facilities provide patients with long-term personal assistance services, but do not provide medical care (although they do provide assistance, such as dispensing medications).

Important: A patient is allowed only a certain number of SNF days per year. If a nursing facility brings a patient to the physician’s office, you should report POS code 11 (Office) on the claim form.

Stay tuned to My Coding Career for more study materials that help you prepare for the Practice Management questions on the CPC exam.

Hate to study alone? There’s a 3-day exam prep training camp coming soon to a city near you.

Which outpatient coders earn the most … and the least.

Contemplating a career jump from physician office to billing company? Or from hospital to payer?

Opportunities for outpatient coders abound, as a recent salary survey from the American Academy of Professional Coders confirms. So it’s useful to learn where those opportunities are and what the average salaries are for each work place.

Keep in mind: Factors such as education level, specialty, certifications and experience also affect medical coders’ salaries, and this survey only reflects the approximately 10,000 AAPC members who responded to the questions. And the number of respondents in each category also may have an effect on results. That said, here’s how the salary averages shake out, by setting:

$75,849 Consultant

$54,643 Payer

$49,680 Insurance Company

$46,795 Government Facility

$44,895 Hospital

$44,035 ASC

$43,660 Coding-related vendor

$43,187 Large Group Practice (11+ Physicians)

$40,714 Medium Group Practice (6-10 Physicians)

$40,301 Small Group Practice (3-5 Physicians)

$39,102 Individual Practice (1-2 Physicians)

$38,021 DME/Pharmacy Company

$37,500 Rehab Center

Tip: There’s a lot more than salary to consider. If you want to learn more about what it’s like to work in a particular health care setting, check out the job postings from the health systems’ human resources department. And network so you can meet coders who work in different health care settings. Get on list serves to chat with coders, or attend an AAPC local chapter meeting to meet other outpatient coders working in your area. Only by talking with coders in other health care settings besides yours can you get a complete picture.

Don’t leave home without it. Wherever you go, your CPC® or specialty coding certification serves you well. Prep to take the exam here.