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POS 13- Assisted Living Facility

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Christy:
If a behavioral health provider (LCSW) sees patients at an assisted living facility (not employed by or contracted with the facility) does s/he need to add the location as an additional billing location (office)?

thanks!

Merry:
The person would be seeing the patient in the patient's home so you would not list the facility as the rules are "other than home or office" So the place of service would be home. Someone please correct me if I am wrong.

Christy:
thanks, Merry. I have been led to believe that I need to list pos 13 "assisted living", although "home" was my first instinct....

anyone have experience with this?

thanks!

RichardP:
Christy and Merry - This is going to sound a bit snarky, although I don't intend it to be.  It is simply an exercise in logic.  I invite both of you to look carefully at the wording on the chart at the following link:

http://www.findacode.com/cms1500-claim-form/cms1500-place-of-service-codes.html

Particularly this:

12 - Home - Location, other than a hospital or other facility, where the patient receives care in a private residence.

13 - Assisted Living Facility    Congregate residential facility with self-contained living units providing assessment of each resident's needs and on-site support 24 hours a day, ...

An assisted living facility is never mistaken for a private residence, even though both could be considered home - if that is where you live.  That is why there is a code for both.  Where care is provided in a private residence, the POS = 12 = home.  Where care is provided in an assisted living facility, the POS = 13 = assisted living facility.

Under what conditions do you suppose a doctor should use POS = 13 = assisted living facility, if not when he sees someone in an assisted living facility?

PMRNC:
It's important to first know that Medicare has their own way of handling mental health benefits in nursing homes, skilled nursing homes and other NON part A related services such as home care.

(1) “Section 1862(a)(1)(A) of
the Social Security Act states that all Medicare Part B services, including mental health services, must be ‘reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member.’”

(2) “For every service billed, providers must indicate the specific sign, symptom, or patient complaint
necessitating the service.”

(3) “CPT and ICD-9-CM codes reported on health insurance claim form should be supported by
documentation in the medical record.”

(4) “Providers should follow the documentation guidance for psychiatric diagnostic or evaluative interview
procedures and psychiatric therapeutic procedures as described in the Physicians’ Current Procedural Terminology"

Additionally:

Local Medical Review Policy Coverage Criteria.

Generally, a patient must have a psychiatric illness and/or emotional or behavioral symptoms for psychiatric therapeutic
procedures such as individual and group psychotherapy to be covered.
Symptoms, goals of therapy, and the patient’s capacity to participate in and benefit from psychotherapy must be
documented in the patient’s medical record. Psychotherapy should improve or maintain a patient’s health status and functioning. Coverage of psychotherapy does not include teaching grooming skills, monitoring activities of daily living, recreational therapy, or social interactions. Individual psychotherapy with medical evaluation and management is covered for physicians only, with exceptions in certain States for appropriately licensed nurse practitioners, clinical
nurse specialists, or physician assistants.

Bottom line.. contact Medicare in your state for best answer. I would think if an LCSW is making home visits to a Medicare Beneficiary there are actual physician orders or something established with the patient.

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