Billing for other services for members in psychiatric residential treatment facilities

Transcription

1 Billing for other services for members in psychiatric residential treatment facilities Summary: Psychiatric residential treatment facilities (PRTF) are an all-inclusive treatment program for children and adolescents in a residential treatment facility. Many services that would normally be planned services that a member in PRTF would need are included in the PRTF per diem rate that is paid to the PRTF provider. However, services that are considered unplanned may be paid to providers outside of the PRTF per diem. The Kansas Department of Health and Environment (KDHE) has developed a list of diagnosis codes that are considered planned and will not be paid outside of the PRTF per diem. These claims should be sent to Amerigroup Kansas, Inc.. Claims for services with diagnosis codes not on this list are to be sent to the KanCare Fiscal Agent. Please note that KDHE may change or add to the list of planned diagnosis codes. What this means to you: When providing services to PRTF members, claims for diagnosis codes outside of those on the Planned Services list are to be sent to KMAP, P.O. Box 3571, Topeka KS Claims for diagnosis codes that are on the Planned Services list can be sent to Amerigroup. What are unplanned services? Unplanned services are those that would not typically be expected to happen during the normal course of the member s stay in PRTF. A few examples of unplanned services would include treatment for appendicitis, broken arm, ingrown toenail or concussion. Diagnosis codes Please see the below diagnosis codes for your use. What if I need assistance? If you have questions, please contact your local Provider Relations representative or call our Provider Services team at KSPEC March 2015 By Provider relations

2 Diagnosis Professional planned description Professional behavioral and health/substance abuse: automatically included Unspecified episodic mood disorder Bipolar disorder unspecified Conduct disorder childhood onset type 7809 Other general symptoms V202 Routine infant or child health check Oppositional defiant disorder Adjustment reaction with withdrawal Attention deficit disorder of childhood with hyperactivity Major depressive affective disorder recurrent episode severe degree without V700 Routine general medical examination at a health care facility V703 Other general medical examination for administrative purposes Other specified pervasive developmental disorders current or active state 2989 Unspecified psychosis Posttraumatic stress disorder V5869 Long-term (current) use of other medications 311 Depressive disorder not elsewhere classified Conduct disorder adolescent onset type Other convulsions 3129 Unspecified disturbance of conduct Bipolar I disorder most recent episode (or current) mixed severe specified as with Nondependent cannabis abuse unspecified use Bipolar I disorder most recent episode (or current) mixed severe without mention of V053 Need for prophylactic vaccination and inoculation against viral hepatitis Major depressive affective disorder recurrent episode severe degree specified as with Schizophreniform disorder unspecified state Bipolar I disorder most recent episode (or current) depressed moderate Other specified conduct disorder not elsewhere classified 3094 Adjustment disorder with mixed disturbance of emotions and conduct 317 Mild intellectual disabilities Other emotional disturbances of childhood or adolescence Bipolar I disorder most recent episode (or current) depressed severe without mention of V705 Health examination of defined subpopulations V5883 Encounter for therapeutic drug monitoring V7231 Routine gynecological examination 4779 Allergic rhinitis cause unspecified

3 49390 Asthma unspecified Major depressive affective disorder recurrent episode moderate degree 3009 Unspecified nonpsychotic mental disorder Major depressive affective disorder single episode unspecified degree Bipolar I disorder most recent episode (or current) manic severe specified as with Intermittent explosive disorder 9779 Poisoning by unspecified drug or medicinal substance V0481 Need for prophylactic vaccination and inoculation against influenza Major depressive affective disorder single episode severe degree without psychotic behavior 2967 Bipolar I disorder most recent episode (or current) unspecified Undersocialized conduct disorder aggressive type moderate degree Bipolar I disorder most recent episode (or current) manic severe without mention of Diagnosis Outpatient planned description V703 Other general medical examination for administrative purposes Unspecified episodic mood disorder V5883 Encounter for therapeutic drug monitoring V5869 Long-term (current) use of other medications 311 Depressive disorder not elsewhere classified Undersocialized conduct disorder aggressive type moderate degree Bipolar disorder unspecified Bipolar I disorder most recent episode (or current) manic unspecified Other convulsions V6751 Follow-up examination following completed treatment with high-risk medication not elsewhere classified Oppositional defiant disorder Attention deficit disorder of childhood with hyperactivity Posttraumatic stress disorder 2989 Unspecified psychosis Epilepsy unspecified without intractable epilepsy 3129 Unspecified disturbance of conduct 3009 Unspecified nonpsychotic mental disorder Major depressive affective disorder recurrent episode severe degree without 7802 Syncope and collapse V2549 Surveillance of other contraceptive method 9654 Poisoning by aromatic analgesics not elsewhere classified Conduct disorder adolescent onset type Bipolar I disorder most recent episode (or current) mixed unspecified

4 88102 Open wound of wrist without complication Other emotional disturbances of childhood or adolescence V6284 Suicidal ideation Anxiety state unspecified Bipolar I disorder most recent episode (or current) mixed severe without mention of 9693 Poisoning by other antipsychotics neuroleptics and major tranquilizers Chronic tonsillitis 9779 Poisoning by unspecified drug or medicinal substance V715 Observation following alleged rape or seduction 9630 Poisoning by antiallergic and antiemetic drugs Altered mental status Asthma unspecified with (acute) exacerbation V202 Routine infant or child health check V700 Routine general medical examination at a health care facility Child sexual abuse Nondependent alcohol abuse unspecified drinking behavior Memory loss Chronic tonsillitis and adenoiditis Alteration of consciousness other Asthma unspecified 9663 Poisoning by other and unspecified anticonvulsants 7804 Dizziness and giddiness Generalized convulsive epilepsy without intractable epilepsy Bipolar I disorder most recent episode (or current) depressed unspecified Major depressive affective disorder single episode severe degree without psychotic behavior Diagnosis Inpatient planned description Unspecified episodic mood disorder Bipolar disorder unspecified Attention deficit disorder of childhood with hyperactivity Posttraumatic stress disorder Major depressive affective disorder recurrent episode severe degree without 2989 Unspecified psychosis Other specified pervasive developmental disorders current or active state Major depressive affective disorder recurrent episode severe degree specified as with Autistic disorder current or active state Other emotional disturbances of childhood or adolescence Bipolar I disorder most recent episode (or current) mixed severe without mention of

5 29660 Bipolar I disorder most recent episode (or current) mixed unspecified Bipolar I disorder most recent episode (or current) mixed severe specified as with Oppositional defiant disorder Major depressive affective disorder recurrent episode unspecified degree Schizoaffective disorder unspecified state Bipolar I disorder most recent episode (or current) depressed unspecified 311 Depressive disorder not elsewhere classified Intermittent explosive disorder Conduct disorder childhood onset type Bipolar I disorder most recent episode (or current) depressed severe specified as with Major depressive affective disorder single episode severe degree without psychotic behavior 2967 Bipolar I disorder most recent episode (or current) unspecified 9947 Asphyxiation and strangulation Unspecified pervasive developmental disorders current or active state Bipolar I disorder most recent episode (or current) depressed severe without mention of Bipolar I disorder most recent episode (or current) mixed mild Paranoid type schizophrenia unspecified state Major depressive affective disorder single episode unspecified degree 3129 Unspecified disturbance of conduct Other and unspecified bipolar disorder other Major depressive affective disorder recurrent episode mild degree Bipolar I disorder most recent episode (or current) manic severe without mention of Bipolar I disorder most recent episode (or current) depressed moderate Bipolar I disorder most recent episode (or current) manic severe specified as with Major depressive affective disorder recurrent episode moderate degree 9654 Poisoning by aromatic analgesics not elsewhere classified Other specified episodic mood disorder Anxiety state unspecified Major depressive affective disorder single episode moderate degree Conduct disorder adolescent onset type 3181 Severe intellectual disabilities 3453 Grand mal status epileptic 9630 Poisoning by antiallergic and antiemetic drugs 9693 Poisoning by other antipsychotics neuroleptics and major tranquilizers Bipolar I disorder most recent episode (or current) manic unspecified Nondependent alcohol abuse unspecified drinking behavior Extrinsic asthma with (acute) exacerbation

6 29564 Schizophrenic disorders residual type chronic state with acute exacerbation