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Angie:
We are a Therapeutic Wilderness Program for mental health/substance abuse. We do not participate with any of the insurance companies. The patient want us to prepare a claim for the program; even though it is not a covered benefit on their plan.  We are not licensed as Residential Treatment as we don't have a building with beds, our license specifically states we are Outdoor Youth Treatment. Can we use the 0861 for the type of bill even though we are not licensed as Residentail Treatment. A third party biller who this family has hired told me that we can bill it as residentail treatment even though we are not licensed as such or bill it as subacute care facility, which we are not licensed as either.....I worry this is misleading to the insurance company. Any advise would be most helpful...

PMRNC:
Best thing to do is give an itemized billing statement to the patient and let them file it. If you are not credentialed you are under no obligation to file, why jump through the hoops when you don't have to?

Angie:
But how do you code an itemized statement for boarding when there is no code for boarding in the wilderness? (sleeping in a tent)
Or for the group sessions that they have every day but the group sessions are not provided directly by the therapist because the therapist is only in the field 2 days a week and those are the only 2 days he directs the actual group session. The other group sessions they have are sessions within the group and held by the field staff who are not licensed therapists.......What code do you use for those???? I don't think you can code those so how do you itemize those on a itemized statement?

PMRNC:

--- Quote ---But how do you code an itemized statement for boarding when there is no code for boarding in the wilderness? (sleeping in a tent)
--- End quote ---

That's probably going to be a POS of other.. but if there's no code, you have to just do what you do. if you do not participate and insurance billing is not something you offer, then BEST you can do is give the patient the itemized bill and let them fight with the insurance company, if the carrier needs or wants something else, have them contact you, there's no obligation on your part other than an itemized bill. HOPEFULLY you collected payment as with other clients, if you let the patient off the hook or with an assignment of benefits than to get paid you set yourself up to jump through the hoops.  My suggestion to avoid this in the future is to have one financial policy that addresses this and making NO exceptions aside from documented hardship cases. (JMO)

Angie:
Thank you for your advice. Another question... Would you use the 90818(Inpatient/Partial Hospital or Residential Treatment) or 90806 (Office or Other Outpatient facility) for the individual sessions? We are not licensed as Residential Treatment or Inpatient nor are we licensed as Outpatient.....What would be the most appropriate?
Anyone else do any wilderness program billing? or do you of someone who does?

Also Linda do you think it would be wrong when we do an itemized statement to use the 90853 Group procedure code everyday to show they had a group and just put *** by the Group sessions to indicate the group was provided directly by the licensed therapist? (The group sessions that we have notes from the licensed therapist) 
I have to have some kind of code to use for an itemized statement if the parents are wanting to submit to their insurance to see if they can get them to reimburse them for anything.
I have seen other programs statements and they are just using the 90853 group everyday but I know the therapist is not the one providing those sessions everyday; they are the field staff not licensed therapists. So it seems to me the best I can do is to indicate which ones are provided directly by the therapist, any thoughts?

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