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Thread: Inpatient H&P by an MD

  1. #1
    Join Date
    Apr 2007
    Iowa City, IA

    Default Inpatient H&P by an MD

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    My MD's are seeing patients on the Inpatient Behavioral Health Unit. When they are assessing the patient for the 1st time (intake 99221-99223) They do a great job getting the CC and HPI. They don't always do a ROS, but they meet the physical exam and the medical decision making. They said they don't do a ROS because they do a psychiatric review of systems not a medical review of systems.
    For this code set (99221-99223) we have to meet 3 of 3 elements for that code. would a psychiatric ROS count?
    Can they bill off of time? 99221 (30 min) 99222 (50 min) 99223 (70 min)
    Would they need to note % of time spent counseling/coordinating care? or what would be the proper verbage for this?
    They really do note a book and I am sure they are meeting the time element, but not sure what to do about the ROS problem. They don't think it needs to be noted because they aren't following the medical issues
    Last edited by sasharea; 03-22-2011 at 07:26 AM. Reason: Does anyone ever answer these?

  2. #2
    Join Date
    Apr 2007


    I have the same problem. It is my understanding that the ROS is still required. Have you considered using 90801? But then, at least in my area, you run into payers only allow a certain number of these to be provided.

  3. #3
    Join Date
    Apr 2007
    Iowa City, IA


    The payers in my area don't want to pay that code if the pt has already been seen in our office before and being admitted to the psych unit.
    My doctors really think the psych rules are different for the 99221-99223 codes, but want me to find the answers.
    It is good that someone responded to this post. Hopefully if I happen to find an answer I will pass it on to you!
    I have posted a question to the APA( American Psychiatric Association) so hopefully they can answer this, but I suspect I will get the same answer I got from medicare...."We aren't allowed to dispense coding advice because we are not coders"

  4. #4

    Default Inpatient H& P on psych

    If your docs are ONLY doing the medical part, then 9922x (Hospital care, initial day.) The psychiatrist will code the 90801 (Initial psych eval.) In our free standing hospital we are having a hard time getting paid for both if they are on the same day with diffferent docs, so I'm not sure how it will work if you are part of a medical hospital

  5. #5

    Default Hospitalists In Psychiatry, Office Manager

    I work for a group of psychiatrists that do inpatient work only. We are having some issues with denials due to the fact that our docs are billing a 99231-99233 for their daily rounding visits, but the internists who are also rounding on these patients for physical problems are also billing these codes. The psychiatrists are not doing psycho therapy regualarly so the 908 codes aren't applicable. It is mostly mediciation management and evaluation of mental status. Any advice on what we should be billing in conjunction with the IM docs?

    We have the same issue of billing 90801's for initial evals and being denied due to a recent (within 6mos. or 1 yr) of a previous charge with the same code. I have been told that if it is within that time frame it must be coded as a 99231.

  6. #6
    Join Date
    Apr 2007
    Iowa City, IA


    I don't know if things are the same in your area as they are in our's, but are you being sure that who ever admits the pt is putting the AI modifier after the 99221-99223 codes? We haven't been having any problems with getting paid as long as they aren't with the same specialty.

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