Psychiatrist Performing Med Management in Field -Which E/M code & POS Should We Use?

Messages
3
Best answers
0
Psychiatrist Performing Med Management in Field -Which E/M code & POS Should We Use?

Our outpatient program psychiatrists sometimes perform medication management sessions out in the field -for example at a Starbucks, at a park, etc. There are various reasons for this (homelessness, etc), but this is generally done because our patients are severely mentally ill so our doctors see them wherever they can. My question is what E/M code and place of service (POS) code combination are appropriate for this situation? We've been using "office" E/M codes (99201-99215) since the description for this E/M code range says "office or other", with field as the place of service (POS code 99). Medicare denies our claims stating POS is inconsistent with service code so we assumed this was just not a payable service. However, I recently heard from another provider that they bill these types of services with "home" E/M codes (99341-99350) and field (POS code 99) and get paid.

We'd love to get paid for these but want to confirm that billing with the "home" E/M codes is appropriate. Does anyone have any information or experience with this. Thanks!!
 
Messages
811
Best answers
0
Our outpatient program psychiatrists sometimes perform medication management sessions out in the field -for example at a Starbucks, at a park, etc. There are various reasons for this (homelessness, etc), but this is generally done because our patients are severely mentally ill so our doctors see them wherever they can. My question is what E/M code and place of service (POS) code combination are appropriate for this situation? We've been using "office" E/M codes (99201-99215) since the description for this E/M code range says "office or other", with field as the place of service (POS code 99). Medicare denies our claims stating POS is inconsistent with service code so we assumed this was just not a payable service. However, I recently heard from another provider that they bill these types of services with "home" E/M codes (99341-99350) and field (POS code 99) and get paid.

We'd love to get paid for these but want to confirm that billing with the "home" E/M codes is appropriate. Does anyone have any information or experience with this. Thanks!!

I read the guidelines for the 99341-99350 range and here's what I got:
"Providers use 99341 to report services given to patients at their private residence, which typically refers to a private home, apartment, town home, or other non–congregate/shared facility living arrangement. Congregate/shared facility living arrangements are places such as assisted living facilities, adult living facilities, and group homes and you report these with 99324 through 99337.

The appropriate E/M service level is based on the medical necessity of performing the key components and also reviewing documentation of the key E/M criteria of the history, exam, and medical decision making, MDM, elements.

The provider also documents the reason why the patient is being seen at their private residence and not at the office and also the time spent with the patient and activities he performs. When he calculates time as an element to assign the code the provider does not include travel time in the code selection.

Use time as the controlling factor to report an office and or other outpatient visit if more than 50% of the total visit time is comprised of counseling and coordination of care."

You could then use POS 12 for Home.

For the other locations, there's POS 04 for Homeless Shelter and then, of course, POS 99. There's always 99499 for Unlisted E/M. I think the key is what I've put in bold type above.

"Unlisted Service
An E/M service may be provided that is not listed in this section of the CPT codebook. When reporting such a service, the appropriate unlisted code may be used to indicate the service, identifying it by "Special Report," as discussed in the following paragraph. The "Unlisted Services" and accompanying codes for the E/M section are as follows:
99429 Unlisted preventive medicine service
99499 Unlisted evaluation and management service

Special Report
An unlisted service or one that is unusual, variable, or new may require a special report demonstrating the medical appropriateness of the service. Pertinent information should include an adequate definition or description of the nature, extent, and need for the procedure and the time, effort, and equipment necessary to provide the service. Additional items that may be included are complexity of symptoms, final diagnosis, pertinent physical findings, diagnostic and therapeutic procedures, concurrent problems, and follow-up care."
 
Top