99223-h&p

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Hello,

I am new to this behavior health/addiction field so I am hoping to get some guidance. (only been here 3 weeks!)

I work for an addiction treatment facility both inpatient and outpatient.

We have an MD that admits the client with a H&P 99223. At that time he gives the patient a TB test and a vivitrol shot if needed.
It is being billed on a hcfa 99223 POS 11, 86580 TB test, J2315 Vivitrol injection. Does that seem right?
He also is the attending on all of the drug screens for the facilities. We currently use G0479 on a Ub and sometimes on a HCFA. I am not sure which one to continue to use, HCFA or UB? I have seen the HCFA deny because the facility tax id is registered as facility and MD is a provider. I am lost...

Then shortly after that a psychologist comes in and does a 90792, it bills on a HCFA also.

They both manage the patients care, calls in medication refills, etc.

He only bills the 90792. Can't he bill for anything else?

AAHHHH HELP!
 

thomas7331

True Blue
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If these services are being done in a facility, then all technical charges including labs, supplies and drugs, need to be billed on the UB form because those are part of your facility's costs - a HCFA form with the place of service code 11 would be inappropriate if your facility is billing charges separately on a UB.

Physician/professional services should be billed on the HCFA 1500 form, but the place of service should reflect where the patient was seen. CPT code 99223 is specifically for inpatient services, so place of service 11 will be incompatible with this code. As for what codes the MD and psychologist should be billing, that largely depends on documentation. I'd note that 90792 includes medical management which in most place is limited to physicians or NPPs, unless you're in a location where psychologists are granted prescription privileges.

Behavioral health is it's own subspecialty of coding, so I'd recommend doing some study in this area to get you familiar with it. Here's a link to the APA's coding page that has a lot of excellent information. In particular, take a look at the presentation titled ''CPT coding for psychiatric care in 2014" which I've found very helpful and which gives a lot of good E/M coding examples:

https://www.psychiatry.org/psychiat...edicare-and-medicaid/coding-and-reimbursement
 

Misdavis

Contributor
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PHP and Place of Service 52

I'm not really answering a question but asking a question as well. If it's a facility PHP situation with place of service 52. Would it be appropriate to report inpatient E/M codes or Outpatient E/M. Previously documentation has stated that inpatient CPT codes (for pro fees) but a newer article that was just presented to me from a compliance watch stated that it could neither??
Psychiatry coding is difficult because there is so much conflicting information out there in regards to staying in compliance.
 

thomas7331

True Blue
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Place of service 52 is for partial hospitalization and is considered outpatient, at least for Medicare, though other payers may have different rules. I agree, psychiatric facility billing is very confusing, all the more so because many commercial payers and Medicaid plans create their own billing guidelines for this and don't follow Medicare's, which makes it especially difficult.
 
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I have done lots of research since posting this. Thank you for the link, it has been very helpful.

If these services are being done in a facility, then all technical charges including labs, supplies and drugs, need to be billed on the UB form because those are part of your facility's costs - a HCFA form with the place of service code 11 would be inappropriate if your facility is billing charges separately on a UB.

Physician/professional services should be billed on the HCFA 1500 form, but the place of service should reflect where the patient was seen. CPT code 99223 is specifically for inpatient services, so place of service 11 will be incompatible with this code. As for what codes the MD and psychologist should be billing, that largely depends on documentation. I'd note that 90792 includes medical management which in most place is limited to physicians or NPPs, unless you're in a location where psychologists are granted prescription privileges.

Behavioral health is it's own subspecialty of coding, so I'd recommend doing some study in this area to get you familiar with it. Here's a link to the APA's coding page that has a lot of excellent information. In particular, take a look at the presentation titled ''CPT coding for psychiatric care in 2014" which I've found very helpful and which gives a lot of good E/M coding examples:

https://www.psychiatry.org/psychiat...edicare-and-medicaid/coding-and-reimbursement
 
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I have done lots of research since posting this. Thank you for the link, it has been very helpful.

Thomas7331- The only carrier we have a problem with now is all the blue payers. They are denying the ub, we are going to try a hcfa. I dont even know what to do. I want to pull my hair out!
 
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