Coding > Coding

Type of Bill

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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?
I have done so much research on this that my eyeballs are bouncing off the sides of my head! Nobody seems to know an answer to this so any advise at all would be of great help!

Michele:
I personally would go with the 90818 since the patient is in a residential treatment program.  It is not an outpatient situation. 

Angie:
What do you think about the group sessions when we do an itemized statement for the family since we don't bill the insurance. We provide the families with an itemized statement and then they submit to their insurance for reimbursement only if requested.
The therapist is in the field two days a week, while he is in the field he will hold an individual and 2 group sessions. The other days of the week they have group sessions that are not provided directly by the licensed therapist and the staff that are doing the groups are not licensed at all, they are field staff that hold groups on topics of books they are reading assigned by the therapist or impact letter groups,etc.. the therapist is not on site 7 days a week. Can we code it as an 90853 and just indicate which ones were provided directly by the licensed therapist? I don't know of any other way to show they have a group everyday because there is no other code and I don't think we can code it if the therapist is not on site or licensed staff are not providing the service.....Thoughts? :-\

Michele:
I honestly don't know on this one.  If the staff is not certified or licensed in any way to perform psychotherapy (90853 is group psychotherapy) then I am not sure it can be indicated with that code.  Even if you flag the ones that are held with the licensed therapist.  It is really more of a legal question than a billing question and I am not qualified to give you advise on that.

Angie:
I understand, Thank you Michele.

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