Wiki e/m set for residential and inpatient SA facilities

[Cavalier40]

From my understanding, a facility that performs SA Detox and Residential care should be using the hospital inpatient e/m set (99231-99233) when reporting physician encounters that medically manage or monitor their care. I was told that the SNF e/m set (99304-99316) is more appropriate since CPT includes psychiatric facilities as part of the definition. Even after audit, I have had no trouble with the hospital set, but is the SNF set actually correct for free standing facilities?

 

[Cavalier40]

I was hoping to get an answer to this.

I am using the hospital e/m but people around here are still insisting I use the SNF set.

 

[EMHaven]

From my understanding, a facility that performs SA Detox and Residential care should be using the hospital inpatient e/m set (99231-99233) when reporting physician encounters that medically manage or monitor their care. I was told that the SNF e/m set (99304-99316) is more appropriate since CPT includes psychiatric facilities as part of the definition. Even after audit, I have had no trouble with the hospital set, but is the SNF set actually correct for free standing facilities?

How are you guys billing out the MD services?

I have been in quite a pickle lately with the billing at an RTC facility. We have a psychiatrist as our medical director (but not an employee), and he sees all our clients for H & Ps, and evals and follows up. We are being told that we can't bill out for those services and that they are bundled in the all inclusive rate. But that the doctor could bill them out separably. Is that correct? How are you guys doing it?

 

[LMBENHOFF]

Pro Fee Codeset for SA Residential Facility

We have 2 Residential Treatment Facilities in Illinois. We currently use the Inpatient E&M codes for New Patient H&P's 99221 thru 99223 and Subsequent visits (including Detox) 99231 - 99233 with Location 55 reported on claims. Currently we have just one payer that want us to use the Domiciliary code set 99324 - 99238 for New Patient services, and 99334 - 99337 for Subsequent visits when reporting Location 55.

We contract with Commercial payers to cover both code sets to be reimbursed separately, and for most part we get paid. The exception is the State funded payers that want these services to be submitted on a UB with HCPHS for medication monitoring.

I suggest looking at the Provider Manuals of the commercial payers you contract with and create a list of which code set they want to see for Location 55 and keep a running list. When contract time rolls around, be sure that all possible codes sets are included in the fee schedule for reimbursement.

It is really hard to get specific help on these services, We should talk!