Wiki Professional services for POS 52 partial hospitalization

[sondra hayden]

I have a question regarding the codes that a psychiatrist may use for billing E&M when rendering serices to a patient admitted to a partial hospitalization program in the outpatient hospital location (POS 52).

The 2013 AMA CPT codebook states that inpatient E&M are used in the partial hospitalization location. However, there seems to be a different guidance from CMS. In partial hospitalization instructions I'm interpreting that the recommendation is for professionals to use the outpatient E&M codes.

Please help with any resource that you may have.

Thank you.

 

[czaniewski]

czaniewski

I am having the same problem with partial hospitalization codes. I also need to know what code to use for PHP discharge. 99238 and 99239 do not get paid by UBH and some Blue Cross plans because they are for inpatient and we are billing the 52 outpatient location. More and more of our docs are using partial hospitalization and IOP and I am running into more and more denials.