# Psychiatry patients in the ED



## Scout4413 (Nov 30, 2010)

I am pretty sure I already know the answer to this question...or the answer that has been given to me but I am going to pose it anyway. 

When you have a psychiatry patient awaiting placement and is in held in the ER for several days, our physicians just do one initial E/M and this is all that is billed. There is ongoing management of this patient with intermittent progress notes documented. 

I am told that the physicians can only charge for one E/M for the entire length of time the patient is held in the ER. We recently had a patient for 9 days.

If the physician documented daily E/M procedures, can we code and bill for these?


I appreciate any input... 
txs
Pam


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## jimbo1231 (Dec 1, 2010)

*that's unusual*

Pam,

I don't think there is much you can do about that. Prolonged Services don't apply to the hospital setting so you can't use them. The only other thought I had is has the hospital considerered an Observation unit? If you are holding patients for multiple days and follow the documentation guidelines for Observation, that might open up using those codes. The issue there is CMS doesn't go for 9 day observation which looks more like boarding. This looks like an issue for hospital administration since there shouldn't be 9 day waits for psychiatric admissions and there is some liablility with having a psych patient in the ED for that long.

jim


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## Scout4413 (Dec 2, 2010)

*Psych pt/ ED*

jim
Thanks so much for your input. I also reviewed the Prolonged Services E/M info and also found that it would not be applicable to this type of encounter.
Unfortunately, in many ERs nationwide mental health patients are housed in ERs awaiting placement in a mental health facilities, etc. Yes, it is a liability housing these patients ..but there is not a choice as you cannot release a patient who is committed to harming themself and others, etc.  Our ER does have a great process in place to manage these patients utilizing law enforcement and the works, etc. 
Our facility is in the process of considering a psych unit.. God help us...
Anyway - this is a "broke system" that does not have a chance getting fixed anytime soon. Our mental health patients suffer and healthcare organizations (ERs) are stuck with cost + resources to manage these patients. 

Pam


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## jimbo1231 (Dec 5, 2010)

*It is broken*

I started out a long time ago working in the mental health system, and I agree the stystem even more broken than the health system in general. As you know, you might wait for days for the transer, and then the patient is released from the mental heath facility in a couple of days, way to soon, and winds up on the streets. And as you know, opening a psych ward will probably be a loss leader for the hospital due to crappy, inconsistent reimbursement. But it might be the right thing for the overall mission of the hospital.

Jim


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