Nursing Home - Need Inputs

Partha

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Mental health provider seeing patient in nursing home billing nursing home visits 99307-99309 and getting denied from Behavioral Health plans. Any suggestions how these services should be billed? Is it ok to bill outpatient/office established?

Suggestions will be greatly appreciated!
 

1073358

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Mental health provider seeing patient in nursing home billing nursing home visits 99307-99309 and getting denied from Behavioral Health plans. Any suggestions how these services should be billed? Is it ok to bill outpatient/office established?

Suggestions will be greatly appreciated!
What is the mental health provider seeing patient for? Purpose of visit? I am thinking billing a mental health code with POS as NH might be better
 

Partha

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Mental health provider is seeing the patients in NH for some mental health problems first as consult and then followup.

When used 99307 reason for denial Dr not allowed to perform in this POS. So, we are thinking of using 99241-99245 for initial consult outpatient and then 99212-99215 for follow up visits.
 

ebredehoeft

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confused

We have some instances that are getting denied as well. We are billing a nursing home visit such as 99307 for a primary care visit and then 99307 for the mental health visit. Primary care visit may be for something like cough or bronchitis and the mental one for dx of DYSARTHRIA. Would using the 99307 be correct or should we use for example 90816 90817?? or a 99211-99215 with POS as nursing home?? I am confused. Oh also keep in mind in this example two different providers. One an MD and the other PMHNP
 
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lhallstrom

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The psych consult needs to be reported with inpatient consultation codes (99251-99255), if the documentation criteria is met. (If consult criteria is not met, use the nursing facility subsequent visit codes.) Nursing facility stays are inpatient--not outpatient services. The subsequent nursing facility visits should be reported using CPT codes 99307 - 99310). Be sure to report with the nursing facility POS 31 or 32.

If you still receive a denial, check to see if another provider saw the patient on the same DOS and used the psych diagnosis. The PCP should not be reporting the mental health diagnosis as primary after requesting a psychiatric consultation. You might need to contact the PCP's office to request they file a corrected claim with a different diagnosis.
 
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