Wiki Post-Admission Physician Evaluation w H&P

[Rmarcushishouse]

This is for commercial payers only.

The rendering physician at our sub acute facility does pre and post admission H&P w assessment and evaluation.
They were billing 99223 which is for a hospital, and we are not a hospital. (residential subacute facility). What code could I use?

HELP! [/SIZE][/FONT]

 

[Vannoyj]

Hello, I just looked up the Place of Service Code(s) and Place of Service Description in CPC 2017 Prof Edition.

55 - Residential Substance Abuse Treatment Facility: a facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board.

57 - Non Residential Substance Abuse Treatment Facility: a location which provides treatment for substance abuse (alcohol and drug) abuse on an ambulatory basis. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing (effective 10/1/03)

Based on your post I do believe the E/M codes for Subsequent Hospital Care section would be appropriate, if the facility is listed as a hospital. I say this because I work directly across the street from such a facility which is an Inpatient, or Outpatient facility for substance abuse (alcohol and drug) abuse.

However, I would like to follow your post to see if someone else has more to share on this topic.

 

[Rmarcushishouse]

Hello, I just looked up the Place of Service Code(s) and Place of Service Description in CPC 2017 Prof Edition.

55 - Residential Substance Abuse Treatment Facility: a facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board.

57 - Non Residential Substance Abuse Treatment Facility: a location which provides treatment for substance abuse (alcohol and drug) abuse on an ambulatory basis. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing (effective 10/1/03)

Based on your post I do believe the E/M codes for Subsequent Hospital Care section would be appropriate, if the facility is listed as a hospital. I say this because I work directly across the street from such a facility which is an Inpatient, or Outpatient facility for substance abuse (alcohol and drug) abuse.

However, I would like to follow your post to see if someone else has more to share on this topic.

Since we are not a hospital, what code would I use to bill with? HCFA or UB? The POS 55 is the appropriate one. TH