Psychiatry Coding & Reimbursement Alert

Question: Our psychiatrist recently performed group psychotherapy for Medicare patients who were part of a partial hospitalization program in the psychiatry facility of our hospital. Since they are part of the partial hospitalization program, I reported G0410 for the group psychotherapy. I reported POS as 51. However, the claim was denied. Please tell me where I am going wrong and how to report this service.

Missouri Subscriber

Answer:  You are right in using the HCPCS code, G0410 (Group psychotherapy other than of a multiple-family group, in a partial hospitalization setting, approximately 45 to 50 minutes) when your psychiatrist provides group psychotherapy for Medicare patients who are in a partial hospitalization program.

You should use the interactive complexity HCPCS code, G0411 (Interactive group psychotherapy, in a partial hospitalization setting, approximately 45 to 50 minutes) if your clinician encountered communication issues with any participants in the group.

However, the reason for the denial of your claim seems to be from not reporting the place of service (POS) with the correct POS code. You have reported the POS as 51 (Inpatient psychiatric facility), assuming that this is the place of service since the service occurred in the hospital. But, you should use POS code 51 only when the patient is an inpatient in the psychiatric facility and not for patients who are part of the partial hospitalization program.

For patients in the partial hospitalization program, you need to report the POS as 52(Psychiatric facility-partial hospitalization). The Centers for Medicare & Medicaid Services defines this as “A facility for the diagnosis and treatment of mental illness that provides a planned therapeutic program for patients who do not require full time hospitalization, but who need broader programs than are possible from outpatient visits to a hospital-based or hospital-affiliated facility.” Also, you should provide adequate documentation that all the guidelines that satisfy reporting the procedure codes were followed.