This is Dr. Jonathan Johnson, MD, MBA, CWSP. I am a board certified wound care provider and surgeon here in the Maryland, D.C., and Virginia area. I am the founder of Comprehensive Wound Care Services. We focus on taking care of patients in the long-term care space, home health, hospital-based, telemedicine, as well as in our office.

What is a place of service code, and how is it used in billing and coding in wound care?

The Places of Service, or POS, is a designation that payers, CMS (Centers for Medicare & Medicaid Services), and MACs (Medicare Administrative Contractor) use to designate where specifically providers are taking care of patients.

For instance, you have a POS of 2, and that essentially means that you are doing a telemedicine visit for a patient who is not in their primary home or residence.

Then, you can move on to multiple places of service. For example, there's a POS 10, which means you are doing a telemedicine visit for a patient taking care of the patient while they are in their home, and you're doing a telemedicine visit. You have a POS 11, which basically means you're taking care of a patient in your physician office setting. You have POS 12, which basically means you're taking care of a patient in home, or at the patient's home, and you are with the patient in live, in person, at that patient's bedside or in their home. You have a POS 13, which basically means you're taking care of a patient in an assisted living organization.

You have your POS 31, which basically means you're taking care of a patient that is in a rehab facility, in a long-term care facility, and then you have a POS 32, taking care of a patient that is in a long-term part of their stay in a specific facility.

Now, there are multiple other places of service, but for the context of this talk, we'll focus on typically where we as wound care providers are delivering care. The most important aspect, just in general from this conversation and this video, is to understand the MAC and the LCD, which is your local coverage determinant. It's very important to make sure you read that to make sure your quality of care and the specifics of your care matches directly with what the LCD is requiring.

So there are different places of service like we previously discussed, and it's really important to make sure you're delivering the right care, as we said before, at each one of these specific places of service.

Does the place of service have an impact on reimbursement for cellular-and-tissue-based products (CTPs)?

The answer is yes. There are specific places of service where it is important to understand where the patient is in that state. It's really important to understand the place of service where you are treating your patient from not only a reimbursement standpoint, but also from a local coverage determinant standpoint. It ensures you are staying within the clinical standards when applying your cellular tissue products, and that the patient is in the correct designation to make sure reimbursement is up to date with what you need and the patient is getting the right correct care.

Where can providers go to learn more about potential limitations or regulations related to CTPs and places of service?

Providers can go to CMS.gov. They can also look at the website of their local MAC and understand the LCDs to make sure they are staying number 1: in compliance and number 2: with standard of care when applying their cellular tissue products to their specific patients in the right designated place of service.

Information regarding coding, coverage, and payment is provided as a service to our audience. Every effort has been made to ensure accuracy. However, HMP and the author do not represent, guarantee, or warranty that coding, coverage, and payment information is error-free and/or that payment will be received.