LadyT: I'm filing these claim the same way we file every other in patient stay with every other insurer on the planet. ChampVA is the only one that seems to recently have a disconnect between the place of service and the CPT codes; I was really hoping to find someone else that had the same issue that had found some resolution. But I appreciate your help and your time and hope you have a GREAT day!!!
Dear Dall, I AGREE WITH YOU that Champ VA is definitely the only payer that is denying the codes that we bill for every other inpatient psychiatric hospital claim. 99222, 99231, 99232 99233 and 99238 for discharge.
I am from Tennessee and I am having the same exact problem
So here is what I do know... I have been told that for POS 51 there are only two CPT codes allowed 90791 and 90792. That is Per Champ VA. they told me there were only two codes so I guessed 90792 because a long time ago we had to do that for Georgia Medicaid to get paid for psychiatric evaluation for inpatient POS 51.
They implemented a new billing system after October 2021 and I think that is the problem. I think Psychiatry was not loaded correctly and that they had someone who had no idea about psychiatric care.
I have a claim from summer of 2022 and it is still not paid except for the first date of service which I rebilled with a 90792 and they paid that initial date only. They denied the 99222 code as can't bill that code with POS 51. However the subsequent and discharge dates are still unpaid. I have called them about twenty five times and have extensive notes. I sent an appeal and now they are telling me they have never received it. I have another claim and I would like to find out what the solution is.
I am super frustrated and I think that their new billing system is the issue because I have been unable to find anything to bill for subsequent or discharge days I have asked them where this new information is on their portal so that I can research what it is that they are wanting. They say it is internal to their system. One CSR told me that they follow Medicare guidelines. That was untrue. It makes no sense if you would only be able to bill an eval code of 90792. You cannot bill that code for the whole stay. I wonder if they think it is like an ER visit hence only the one code. They won't provide information and they say they can't tell us how to bill AND they won't provide a resource for information. Apparently it is top secret. They have been so unhelpful. I guess I will send another appeal.
I am just glad to know that I am not the only one with this situation which is quite ridiculous to me.
AT the very least they should have a resource to consult on their website about billing guidelines.
Frustrated in Tennessee