Wiki Medical Exam for Psychiatric Hospital Admission

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Hello all,

I have a physician who provides medical assessments for patients who have been admitted to a local psychiatric hospital. Frequently, there is no medical diagnosis, as the patient has no medical complaints or symptoms. In those circumstances, I am billing an inpatient initial evaluation (99221 - 99223 depending on complexity of history, etc) with a dx of Z02.89. Medicare has been denying our claims as non-covered because of the diagnosis.

I was hoping that someone here would be able to point me to a better diagnosis to represent the service that the physician is performing. Any thoughts? I truly feel that the Z02.89 is the "closest" option I had available to provide medical necessity.

I am aware that SNF codes should be used in this POS (per CMS guidelines) but the facility has informed me that all physicians rounding in their hospitals bill inpatient eval codes and requested that I do the same (I believe it has to do with how they are credentialed with NPPES).

Thanks for any help/thoughts/feedback. I appreciate it!
 
What is the reason for the admission to the psychiatric hospital? I am not a psych coder but there has to be something wrong that triggers the admission and not "just because", right? :)
 
Correct. These patients are being admitted for psychiatric issues only. However, it is an acute inpatient psych hospital, so frequently, patients also have acute or chronic medical issues that are also treated there. My physician is called to consult (essentially) on new patient admits to determine if any medical care/oversight will be needed. He is also called in to treat when a patient has a medical event. My understanding is that the hospital has an obligation to ensure that patients are being treated for all ailments even though it is a psych facility. Thanks!
 
I understand now. Apologies...I didn't realize your physician is providing a medical consult. Since nothing was found on exam, I would use the reason for admission as primary since that's really why he was asked to see the patient and list the Z code secondary. I'm curious to see if anyone else with more experience in this chimes in. Good luck :)
 
Have you tried Z02.2- Encounter for examination for admission to residential institution? I work at a PRTF, and we use Z02.2 as the dx for some of the lab tests at admission. Medicaid and private insurance both pay. Maybe Z02.89 is not specific enough?
 
I understand now. Apologies...I didn't realize your physician is providing a medical consult. Since nothing was found on exam, I would use the reason for admission as primary since that's really why he was asked to see the patient and list the Z code secondary. I'm curious to see if anyone else with more experience in this chimes in. Good luck :)

No worries! I appreciate your input! And it is always hard to explain clearly (for me) when posting a new thread.

My understanding is that if we are not treating the condition (he does not treat BEH dx) then we cannot use that as the primary diagnosis. Am I being too black and white with this coding concept?

Thanks again!
 
Have you tried Z02.2- Encounter for examination for admission to residential institution? I work at a PRTF, and we use Z02.2 as the dx for some of the lab tests at admission. Medicaid and private insurance both pay. Maybe Z02.89 is not specific enough?
We have not! I was avoiding that dx because it is acute inpatient and I was not sure that it qualified as "residential".

I appreciate your feedback - we will take a look at this and see if it makes a better fit for the service we are providing.

Have a great day!
 
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