Wiki IOP (intensive outpatient program)

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tgenia

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Hi,
One of my providers is looking into starting an IOP. I was able to come across some codes they may be able to use, if there is a GURU out there please let me know if I missed any CPT'S.
Thanks
90791,90792,99211-99215
 
90791 Psychiatric Diagnostic Examination without medical services

90792 Psychiatric Diagnostic Examination with medical services

+90785 - Use the add-on code with 90791 or 90792 for interactive psychiatric
diagnostic interview examination using play equipment, physical devices,
language interpreter, or other mechanisms of communication

90832 Individual psychotherapy, insight oriented, behavior modifying and/or supportive,
30 minutes with the patient and/or family member (time range 16-37 minutes)

+90833 - Use add-on code for Individual psychotherapy, insight oriented,
behavior modifying and/or supportive, 30 minutes with the patient and/or family
member (time range 16-37 minutes), when performed with an evaluation and
management service.

90834 Individual psychotherapy, insight oriented, behavior modifying and/or supportive,
45 minutes with the patient and/or family member (time range 38-52 minutes)

+90836 - Use add-on code for Individual psychotherapy, insight oriented,
behavior modifying and/or supportive, 45 minutes with the patient and/or family
member (time range 38-52 minutes) when performed with an evaluation and
management service.

90837 Individual psychotherapy, insight oriented, behavior modifying and/or supportive,
60 minutes with the patient and/or family member (time range 53 minutes or
more)

+90838 - Use add-on code for Individual psychotherapy, insight oriented,
behavior modifying and/or supportive, 60 minutes with the patient and/or family
member (time range 53 minutes or more), when performed with an evaluation and
management service.

+90785 - Use the add-on code with 90832, +90833, 90834, +90836, 90837 and

+90838 for interactive psychotherapy using play equipment, physical devices,
language interpreter, or other mechanisms of communication

90839 ? Psytx crisis initial 60 minutes

90845 ? Psychoanalysis
 
IOP Billing

We have a provider and he wants to use 99221-99223 and 99231-99233 when seeing patient in an IOP, are these codes acceptable?
 
IOP, PHP, In hsopital

I need additional direction, how do you determine if you use an E/M or psychotherapy code?
 
IOP Code

Hi,

If the facility is going to be licensed for IOP then they will want to bill using H0015 with rev code 906 if substance abuse and 905 if a psych diagnosis on a UB04. If the facility acquires a CLIA waived license they can also bill for periodic urinalysis testing under 80300 and rev code 300 or the G0434 code with 300 rev code and bill the UA's on a seperate UB04 not together with the IOP days. Use modifier 59 if billed on the same day as the IOP sessions.
Those other codes 90791, 90837, etc can be billed separately on a UB04 but will get reimbursed according to the insurance carrier.
I bill primarily for treatment facilities, PHP, IOP OP
BCBS of FL has just eliminated facility billing for the 914 90837 and 915 90835 out patient codes. They also bundle in the UA's but some out of state BCBS will reimburse for them.

Hope this helps : )
 
Iop

Yes but we are doing the billing for the Psychiatrist not the facility, what is the correct POS for an IOP 52 or 22?
 
Hi Debbie,

If billing on a HCFA for the psychiatrist I would use 11 for the office, 22 is for out patient hospital and I believe would be billed on a UB04 and 52 is for psychiatric facility partial hospitalization so also on a UB04 claim form : )
 
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