Clarifying Care Plan oversight-PLEASE HELP

ljhaley@gmail.com

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Hi everyone!
I have a pediatric pt who has been admitted to a psychiatric inpatient facility. The parents are in constant contact with my doc, regarding progress, transfers, etc. My doc has been tracking her attempts to connect with the parents, the unit, various counselors, etc. My doc documents her call attempts (1 min, 3 min, etc) and any conversations she has had with unit counselors, staff, or parents. (10 min, 18 min, etc.) The child came out of the unit, but right back 24hr later after ER visit. My doc submitted all of this time throughout the month (tot-60 min) to be billed as CPO. I have read the guidelines and nothing "feels" right. It's not care in Home, home healthcare, hospice, SNF (traditional), or a domiciliary or rest home. There is no "nursing care" other than passing meds, which pt was NOT given. The parents contacted the Doc, but the unit never initiated contact-so can I really say "recurrent supervision of therapy" was "required"? We aren't Medicare, so if ANY code maybe 99380? I don't think we are meeting the bar here to bill-Thoughts? Suggestions anyone? THANK YOU!
 

jonique.dietzen

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I would suggest reviewing the Transitional Care Management Services 99495-99496. There is a specific list of criteria that need to be met. If the documentation does not support these codes, it may not be billable because I do not think that the services fit into any other categories.

Jonique Dietzen, CPC
 

ljhaley@gmail.com

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Jonique, THANK YOU for responding, and presenting another possible path. Unfortunately pt has not been back in the office after d/c, just been re-admitted to multiple facilities, so those codes won't work for now.
At least I know I tried every possible avenue for compensation for my doc!
Always good to tuck into my special info folder :)
 
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