Wiki Coding help needed!

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jdibble

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I have just been asked to review the coding of our Behavioral group and I have no idea how to do Psych! Any basic info on this would be great! I think the group sees Outpatient and they also have inpatient (What is Partial Hospital?).

My billing department sent back a question which I am not sure how to answer. They want to know if they can use discharge codes 99238 and 99239 for Partial Hospital codes 90817, 90819 or 90822? My question to this would also be with these codes would you bill an EM code separately, or does this code include EM charges? Do the psychologists or psyciatrists bill inpatient and outpatient EM codes along with the therapy codes?

Any guidance would be greatly appreciated! :eek:

Thanks

Jodi Dibble, CPC
 
Hi Jodie. As an auditor and someone who has worked in the billing end of a psych facility for number of years, I can answer some of your questions.

Partial hospitalization (aka intensive outpatient services) in the psych world means that the patient goes to a more structured outpatient therapy environment than an office session. Usually PH lasts about 6-8 hours and the patient goes home at the end of the day (much like work or school). Typical programs can run a week or more. Think of PH as psych services not requiring the overnight stays of a full inpatient psych hospitalization, but requiring much more than a 50-minute office session.

The code series 90816 - 90829 cover inpatient, partial hospitalization, and residential treatment settings for professional services. Some codes are for therapy services alone, while others include an E/M component along with the therapy. All the codes are time-based, so it's important for the provider to document face-to-face time.

Also important to consider are the types of providers you will bill for. Are they psychiatrists, psychologists, social workers? Your state billing laws may vary according to provider types.

Hospital discharge codes 99238 and 99239 bump up against NCCI edits, so it's not advisable to bill the discharge codes when reporting codes 90816 - 90829.

As far as coding resouces go, start with CPT and CPT Assistant. CMS also has some good info on their website. Interestingly enough, CPT published a Handbook for Psychiatrists in 2004, but it's now six years old, so use it with caution.

Best of Luck,
Jettman, CPC, CPC-H
Coding Auditor
 
Thank you

Thank you Jettman for your help! I will check out those resources too.

One more question, if you don't mind - if you wouldn't use the E/M discharge codes, would there be another set of codes for billing a discharge, or do you just use the therapy time codes for that too?

Thanks,

Jodi Dibble, CPC
 
Jodie, Behavioral Health providers don't provide discharge services in terms of the "medical" codes 99238 and 99239. There are no professional d/c codes for them that I know of. The facility can bill those codes on day of discharge (if I remember correctly) on a UB. We never billed them because we never got paid for day of discharge.

I'd check with other psych facilities in your state to see how they bill, or ask your carrriers.

Please feel free to send me a PM if you get stuck.

Best,
J-Man
 
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