23 hour observation for SA

Cavalier40

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Stuart, FL Sailfish Chapter
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In the substance abuse world, you deal with relapse quite a bit. Clients will go through detox and then be at an outpatient PHP or IOP level and then use. If they have been clean for a while, a single day of use does not constitute an inpatient stay, but at the same time, they need to be removed from the current treatment environment and make sure that they are medically stable and without PAWS before returning to the outpatient treatment environment.

Our group runs both a free standing sub acute detox center and an outpatient center with all levels of care, so I had the idea of using observation codes if they are found using but not eligible to go back to detox or short term residential care, but I am not sure if they are appropriate in a non hospital sub acute setting.

So I have the following questions

Will the code set 99218-99220 and 99234-99236 work with a POS of 57?

Would this be a facility charge? If so what rev code should I bill under (I am thinking 0900).

Can the MD medical director order the observation and have the ARNP or PA examine?

What documentation would I need besides an MD order and periodic notes to verify that they are in observation more than 8 hours.

Thanks in advance for any guidance in this
 
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