# 3 day psych hold in ED



## colsonccsp@yahoo.com (Apr 9, 2014)

Suicidal patient comes in through the ER requesting admission for fear of hurting him or her self. 

Patient is held in ED for 3 days until a bed can be found in a nearby psychiatric facility. 

How in the world should this be coded for the facility to get paid for 3 days of holding this patient in the ED? (procedure not diagnosis) 

I am stumped and looking for any suggestions.


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## jimbo1231 (Apr 10, 2014)

*Suicide Ideation?*

Well you at a minimum have suicide ideation. Probably depression or severe depression based on documentation. Justifying three days is another issue. If the patient was effectively being boarded and waiting that is tricky. But if the patient remained depressed and suicidal for 3 days you do have medical necessity. Since we are discussing Observation, any chance patient was admitted to an Observation Unit? I'm guessing more like on a gurny in a hall which can be problematic.


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## Nancy R Parent (Apr 14, 2014)

Unfortunately, my state (NH) has a shortage of psychiatric beds, so we have patients waiting up to a week.  We have to get 1:1 sitters for them, to free up RN's to take care of other psych patients in the same area.  We charge a Level 5.  If any one has any other ideas, I'd love to hear it.


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## colsonccsp@yahoo.com (May 1, 2014)

The patient was held in the ED and not roomed anywhere. They were discharged from the ED to the psych program they got a bed in.


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## jimbo1231 (May 2, 2014)

*Agree*

Then I agree with Nancy that we are probably  looking at a 99284 or 99285 depending on documentation and medical necessity. Unfortunatley the ED and patient are victims of a very slow moving mental health system (except when it comes to discharging patients from mental health facilities...often way too fast...).

Jim S.


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## Hammerhead40 (Aug 14, 2014)

I had the sort of the same Scenario.  Patient came in Emergency Room and stayed 3 nights.  His diagnosis was major depressive order (296.20) and  Oppositional defiant disorder (313.81).  Patient was discharged to a Psychiatric Facility.  Provider billed a 99285 for 1 day but the Statement covers period is for 4 days.   In this case is it appropriate for the hospital to bill 1 day in ED no matter what the Length of Stay is?  Help.....


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