Author Topic: Coding Question  (Read 2131 times)

Angie

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Coding Question
« on: February 29, 2012, 12:17:16 PM »
If you were itemizing services for a "Therapeutic Wilderness Program" what code would you use for the Individual Face to Face Session?
90806 Outpatient or 90818 Inpatient
They do stay with us 24/7 but the insurance companies do not recognize "Wilderness Programs" and there are no codes for them. :-\  We are not licensed as RTC we are licensed as "Therapeutic Wilderness Program".
I have seen other Wilderness Programs itemized statements and they all do it different and are the same as us. Some use the 90806 and some use the 90818.

Any advice would be greatly appreciated!

rdmoore2003

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Re: Coding Question
« Reply #1 on: February 29, 2012, 04:45:38 PM »
90806 is used as a "professional" and 90818 is an inpatient code
Regina

Angie

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Re: Coding Question
« Reply #2 on: February 29, 2012, 05:18:21 PM »
Thank you.
I understand the coding but I am just wondering which would be the most appropriate to use since we are a Wilderness Program. We are in a sense inpatient; just in the wilderness and not in a physical building so I was just trying to get someone else opinion on which would be the most appropriate to use......Some have said 90806 and some have said 90818....

PMRNC

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Re: Coding Question
« Reply #3 on: February 29, 2012, 06:30:18 PM »
Your place of service is probably what will differentiate this. You would need to use POS  Other (99)  Insurance are not going to cover it most likely, best to check with them and see if they have any particular way they want it submitted.
Linda Walker
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Angie

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Re: Coding Question
« Reply #4 on: March 01, 2012, 09:43:56 AM »
I know it probably is not going to be covered but the family would like us to prepare something for them because they want to submit it and if it gets denied they are going to appeal it themselves....
I called the insurance but they told me that since we are not contract that they cannot give us codes or tell us how to bill.....
I know that Michele had said she has billed for Wilderness Programs before so I was wondering what she used; Inpatient or Outpatient codes.....
Wish there were codes for Wilderness Programs.......

PMRNC

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Re: Coding Question
« Reply #5 on: March 01, 2012, 11:00:15 AM »
Your procedure codes are not really the problem. You can use the therapy codes. It's your place of service. And since you know the insurance isn't going to cover it, it's really not going to matter. When the carrier denies and patient appeals, at most you'll just need to give them a letter describing services and where they were performed, your not obligated beyond that point. 

That's correct that the insurance company can not guide with coding, they are not allowed to. You should go on and use the applicable therapy codes and make the place of service code 99 (other). You also could give them a letter on the facility stationary that would describe the services and where it's located.   Not likely they are going to be successful at getting it paid at full unless it's a self-funded plan.
Linda Walker
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Angie

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Re: Coding Question
« Reply #6 on: March 01, 2012, 12:41:26 PM »
THANK YOU!

PMRNC

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Re: Coding Question
« Reply #7 on: March 06, 2012, 07:28:45 AM »
Angie, I was just posting some updates to POS codes and ran across one that has been there but I never paid much attention to and it might be something you could try.

POS - 16   Temporary Lodging    Description: A short term accomondation such as a hotel camp ground hotel, cruise ship or resort where patient receives care, and which is not identified by any other POS code.   

In looking at that.. I can't see why you could NOT use that POS code.. if a cruise ship can... lol
Linda Walker
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Angie

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Re: Coding Question
« Reply #8 on: March 07, 2012, 11:46:44 AM »
 ;) LOL! Isn't that the truth!
Thanks Linda for all of your helpful advise, ALWAYS!!!

PMRNC

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Re: Coding Question
« Reply #9 on: March 07, 2012, 11:47:23 AM »
Your welcome! let me know how that works out!
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com