Inpatient Psychotherapy Documentation Requirements

[Dharma]

Hi folks! I have been finding myself providing either CBT or Brief Psychodynamic approaches on the inpatient unit and figured since I am putting in the time and effort (my toughest patients) I should at least generate the RVU's. These will add up over the course of a year and could effect my bottom line. I have at least 3 or 4 encounters daily that legitimately qualify for a 90833 however I am not exactly sure what I need documentation wise.

Do I need a separate treatment plan note? If so any recommended templates or dot phrases? Can I simply add any pertinent information to my standard note? Can I bill consecutive days for therapy for the same patient? I understand I need to include time spent on psychotherapy, details regarding modality of therapy and justification for such but kind of clueless beyond this. Any tips? Thanks all!

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[splik]

you only need to put the type of therapy, techniques, time spent, goals, and should list that you are providing brief therapeutic interventions in the problem bases treatment plan. that is it

 

[Stagg737]

you only need to put the type of therapy, techniques, time spent, goals, and should list that you are providing brief therapeutic interventions in the problem bases treatment plan. that is it

Is it still just the 90833/90837 codes or are there separate codes for this?

 

[Dharma]

you only need to put the type of therapy, techniques, time spent, goals, and should list that you are providing brief therapeutic interventions in the problem bases treatment plan. that is it

Thanks splik! Stupid question, but can I just tag this onto my standard note for the day or do I need separate documentation? Ok to do daily if justifiable?

 

[calvnandhobbs68]

1) I don't see anywhere that 90833 codes can't be billed with inpatient E+M codes. From what I'm reading it seems like you can just document it the same way you'd do outpatient however that being said....

2) I'd highly suspect insurance will deny these add-ons. The patients already receive group therapy every day as part of being on the inpatient unit and insurance knows that. Just like in outpatient where insurance will often deny one of the claims if you bill a psychotherapy add on and then the patient goes to a therapist who then submits some sort of code for therapy as well on the same day...they'll typically only allow the same type of service to be performed once on the same day.

 

[WisNeuro]

2) I'd highly suspect insurance will deny these add-ons. The patients already receive group therapy every day as part of being on the inpatient unit and insurance knows that. Just like in outpatient where insurance will often deny one of the claims if you bill a psychotherapy add on and then the patient goes to a therapist who then submits some sort of code for therapy as well on the same day...they'll typically only allow the same type of service to be performed once on the same day.

Exactly, while insurers may cover multiple therapists, say if someone is in individual and couples, they can deny coverage for therapy that purports to treat the same MH disorder. Further, if you're trying to bill daily, they can deny coverage based on medical necessity that the condition needs daily coverage from multiple providers. This can work for intensive types of inpatient therapies, such as true DBT, but I believe the documentation has to be there.

 

[nexus73]

In my experience inpatient therapy codes get paid. Individual therapy is different than group therapy and provides distinct benefits for patient’s unique problems.

 

[Merovinge]

In my experience inpatient therapy codes get paid. Individual therapy is different than group therapy and provides distinct benefits for patient’s unique problems.

I've certainly seen places where this is true and is done with essentially all the inpatients. I imagine there are other regions/locations where it might not be, unclear to me why the difference exists.

 

[calvnandhobbs68]

In my experience inpatient therapy codes get paid. Individual therapy is different than group therapy and provides distinct benefits for patient’s unique problems.

I mean I know that and you know that but United Healthcare seems to not know a lot of these things for some weird (cough money cough) reason...

 

[splik]

Thanks splik! Stupid question, but can I just tag this onto my standard note for the day or do I need separate documentation? Ok to do daily if justifiable?

You can just include it in your standard note template. You could also adapt your template to include modality and duration of psychotherapy provided. This is also true for consults as well as inpatient.

There is no issue with billing these codes daily if provided. The patients are hospitalized thus the service is likely medically necessary. Groups are irrelevant and many facilities don't bill for group therapy services because they are provided by staff who aren't able to bill and the services are bundled into the daily cost of the hospitalization unlike professional fees.

Medicare reliably pays for inpatient psychotherapy add on codes. Medicaid may not (but in many areas they do not pay for add-on codes at all regardless of setting). Commercial insurances vary but the better ones do pay.

 

[Dharma]

You can just include it in your standard note template. You could also adapt your template to include modality and duration of psychotherapy provided. This is also true for consults as well as inpatient.

There is no issue with billing these codes daily if provided. The patients are hospitalized thus the service is likely medically necessary. Groups are irrelevant and many facilities don't bill for group therapy services because they are provided by staff who aren't able to bill and the services are bundled into the daily cost of the hospitalization unlike professional fees.

Medicare reliably pays for inpatient psychotherapy add on codes. Medicaid may not (but in many areas they do not pay for add-on codes at all regardless of setting). Commercial insurances vary but the better ones do pay.

Appreciate the information here splik. It was very helpful this week on the inpatient unit. We'll see how it pans out on the reimbursement side however I will likely keep on going forward with it either way.