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Place of Service

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Angie:
What would be the appropriate E/M code for services provided within a Residential Treatment Center for mental health?
We are not outpatient; we are not a hospital; and we are not a nursing facility which is what residential treatment falls under in the description but claims are being denied because we are not a nursing facility.
This would be for when our psychiatrist comes to the facility and see's the patient in his office at the RTC and it is a separate fee from the R&B.
Would we fall under hospital inpatient services?????

Michele:
Wow, I keep starting my answer and then backing up because my answer isn't right!  This is a tough one.  Since the psychiatrist is usually billing for medication management you may want to use M0064.  But if they are doing more than medication management that is tough.  The E&M for office visits is not appropriate but I don't believe inpatient hospital is either. 

Anybody else come across this?

PMRNC:

--- Quote ---This would be for when our psychiatrist comes to the facility and see's the patient in his office at the RTC and it is a separate fee from the R&B
--- End quote ---

I agree with Michele IF the psychiatrist is doing med checks only. I have clients who visit nursing homes and this is how we bill using M0064. A few years ago Medicare started to red flag the 90862 for physicians visiting nursing homes/facilities. I used to tell them use the M0064 if your popping in on the patient and dealing with medication management only.  I really think in your situation for what you do over there.. you need a raise  ::) :o  Those physicians should be telling you what codes to use as they are the one in the rooms.

rdmoore2003:
how are set up with insurances?  are you set as a facility?  place of service should be = to how your set up.

Angie:
We are a Residential Treatment Facility but there are NO codes for Residential Treatment Facility for that type of service other than under "Nursing Facility Services" that is what RTC falls under per the CPT code book. It is strictly E/M services for the psychiatrist; no med mang; just the E/M visits.

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