Inpatient Facility Coding & Compliance Alert

Question: Our psychiatrist performed group psychotherapy for Medicare patients who were part of a partial hospitalization program in the hospital’s psychiatry facility. I reported G0410 for the group psychotherapy with POS as 51. However, the claim was denied. Please help.

Iowa Subscriber

Answer: You did correctly use the HCPCS code, G0410 (Group psychotherapy other than of a multiple-family group, in a partial hospitalization setting, approximately 45 to 50 minutes).

You should also use the interactive complexity HCPCS code, G0411 (Interactive group psychotherapy, in a partial hospitalization setting, approximately 45 to 50 minutes) if your clinician encountered communication issues with any participants in the group.

The reason for the denial of your claim could be an incorrect POS code. You should use POS code 51 only when the patient is an inpatient in the psychiatric facility and not for patients who are part of the partial hospitalization program.

In such cases, report the POS as 52(Psychiatric facility-partial hospitalization). CMS defines this as “A facility for the diagnosis and treatment of mental illness that provides a planned therapeutic program for patients who do not require full time hospitalization, but who need broader programs than are possible from outpatient visits to a hospital-based or hospital-affiliated facility.” Also, remember to provide adequate documentation according to the guidelines for reporting the procedure codes.