Wiki Coding question

[jgrubbs21@yahoo.com]

I hope this is the correct place to post this, I am new to all of this. I work at for a behavioral health group and we have provider that sees patients in the hospital. She is currently using 99233 and it gets denied by Medicaid/Medicare every single time. They are saying that it is a non-billable code for behavioral health multi specialty group. Does anyone have any coding suggestions?

 

[thomas7331]

What provider type is she? And what services is she performing in the hospital - do you have a copy of a note as an example? It's impossible to recommend a code without knowing what is documented.

 

[Orthocoderpgu]

I hope this is the correct place to post this, I am new to all of this. I work at for a behavioral health group and we have provider that sees patients in the hospital. She is currently using 99233 and it gets denied by Medicaid/Medicare every single time. They are saying that it is a non-billable code for behavioral health multi specialty group. Does anyone have any coding suggestions?

Totally agree with Thomas. Code 99233 is for treating medical issues. This code also requires high MDM. From your statement it sounds like your provider could be using this code for most visits, if true, would be a red flag. You would not expect this code to be used on a routine basis. Normally for inpatients 99233 might be used once or twice but afterword 99232 and then 99231 which should be used much more than the previous two.

 

[SharonCollachi]

There may be a more appropriate mental health procedure code. Also, what type of provider is important. We had an LCSW in our group who wanted to see people in the hospital (this was about 20 years ago). At that time, we found that she could not get paid for those services, as they were considered "social work" and that is included in the payment to the facility. It would be like trying to bill nursing services separately from the facility fee.