Q: I have gotten some conflicting information I hope you can clear up. On the standard CMS 1500, specifically block 24B, what is required to show place of service? I recently heard it is a number, but I have always used "O" for office.
A: You are correct in that there is a considerable amount of confusion when it comes to the requirements of block 24B and for that matter, 24C, which is for type of service. First, the code indicating place of service is always a number, not a letter. The number is always two digits and represents the various locations that a patient may receive services.
The more common place-of-service codes are as follows:
11 - Doctor's Office
12 - Patient's Home
13 - Assisted-Living Facility
14 - Group Home
20 - Urgent Care Facility
21 - Inpatient Hospital
22 - Outpatient Hospital
It is obvious from this list that the most commonly used place-of-service code is 11. Of course, if you care for patients in one of the other facilities listed and have the privileges to treat in such facilities, those codes would be appropriate. All of the place-of-service codes (there are more than 45) can be found in the front index of the CPT code book, although it is rare for a chiropractic office to use something other than what is listed above.
Block 24B is unchanged for the updated CMS 1500 and will continue to require the two-digit type of service, as is done on the current CMS 1500 form.
On the current CMS 1500, block 24C is for type of service. This block also contains only a number, although it is single-digit only (so as not to confuse with the two-digit place of service).
Types of service are represented in the following manner:
1 - Medical Care
2 - Surgery
3 - Consultation
4 - Diagnostic X-ray
5 - Diagnostic Laboratory
6 - Radiation Therapy
7 - Anesthesia
8 - Assistance at Surgery
9 - Other Medical Service
0 - Blood or Packed Red Cells
From this list, it becomes apparent that in a chiropractic office setting, the most common type of service is 1 - Medical Care, but there would be occasion to use 4 - X-ray. This block was utilized for health insurance claims but was always left blank on Medicare claims. On the updated CMS 1500 that goes into effect January 2007, the "Type of Service" designation is being eliminated and will no longer be required. On the updated form, block 24C is now for "EMG," which represents "emergency indicator," and is not required on a chiropractic claim.
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