Wiki Hosptialist Rounding at Behavioral Health Hospital

[WendyBCimpar]

Hello All,
I work for a hospitalist group that provides rounding services for a behavioral health hospital.
We are experiencing some denials for our admits and subsequent visits. The facility obtains the preauthorizations S9480 for the stays.

Does anyone have any experience with this and any tips on how to approach appeal and better processes?

WendyB

 

[TThivierge]

Hi Wendy
Are they using a bunch of nondescriptive dx codes such as Substance Abuse ( instead of listing cocaine F14 , cannabis, alcohol F10 for instance) and using Unspecified dx codes? The provider need to be more details in dx code selection . The ICD10 manual has given more details in behavior health. Check out details in dx blocks of F32, F02 F03 .Also they should document adjectives related to patient s problem see dx block of R45. Also most behavioral health has cap on amount of service done for the year. Oh yes most payers not cover dx F15 -F19. Also document and assess other symptoms patient is having Insomnia, Paranoia, Excessive Crying but learn Excludes 1 rules too..
I hope helped you.
Lady T

 

[ckeeney]

Hello All,
I work for a hospitalist group that provides rounding services for a behavioral health hospital.
We are experiencing some denials for our admits and subsequent visits. The facility obtains the preauthorizations S9480 for the stays.

Does anyone have any experience with this and any tips on how to approach appeal and better processes?

WendyB

What CPT and POS codes are being used for the hospitalists' rounds? The S9480 is for Intensive Outpatient services, per diem (and Medicare does not pay). I am curious about the use of the S9480 at this facility. Are your hospitalists doing medical (non-behavioral health) inpatient or outpatient care? Is the care SUDS? I work for a behavioral health facility with an inpatient unit (POS 51) and we use this POS with the hospital admit/subsequent visit codes for our psychiatrists. We do have contract non-psychiatric medical providers (non-credentialed through our facility) and since their services overlap with the psychiatrists', we do not bill nor would we get paid for these services. These providers receive payment for their services through a contract arrangement with us.