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 66601. 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 1-800-454-3730. KSPEC-0730-15 March 2015 By Provider relations
Diagnosis Professional planned description Professional behavioral and health/substance abuse: automatically included 29690 Unspecified episodic mood disorder 29680 Bipolar disorder unspecified 31281 Conduct disorder childhood onset type 7809 Other general symptoms V202 Routine infant or child health check 31381 Oppositional defiant disorder 30983 Adjustment reaction with withdrawal 31401 Attention deficit disorder of childhood with hyperactivity Major depressive affective disorder recurrent episode severe degree without 29633 V700 Routine general medical examination at a health care facility V703 Other general medical examination for administrative purposes 29980 Other specified pervasive developmental disorders current or active state 2989 Unspecified psychosis 30981 Posttraumatic stress disorder V5869 Long-term (current) use of other medications 311 Depressive disorder not elsewhere classified 31282 Conduct disorder adolescent onset type 78039 Other convulsions 3129 Unspecified disturbance of conduct Bipolar I disorder most recent episode (or current) mixed severe specified as with 29664 30520 Nondependent cannabis abuse unspecified use Bipolar I disorder most recent episode (or current) mixed severe without mention of 29663 V053 Need for prophylactic vaccination and inoculation against viral hepatitis Major depressive affective disorder recurrent episode severe degree specified as 29634 with 29540 Schizophreniform disorder unspecified state 29652 Bipolar I disorder most recent episode (or current) depressed moderate 31289 Other specified conduct disorder not elsewhere classified 3094 Adjustment disorder with mixed disturbance of emotions and conduct 317 Mild intellectual disabilities 31389 Other emotional disturbances of childhood or adolescence Bipolar I disorder most recent episode (or current) depressed severe without 29653 mention of V705 Health examination of defined subpopulations V5883 Encounter for therapeutic drug monitoring V7231 Routine gynecological examination 4779 Allergic rhinitis cause unspecified
49390 Asthma unspecified 29632 Major depressive affective disorder recurrent episode moderate degree 3009 Unspecified nonpsychotic mental disorder 29620 Major depressive affective disorder single episode unspecified degree Bipolar I disorder most recent episode (or current) manic severe specified as with 29644 31234 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 29623 behavior 2967 Bipolar I disorder most recent episode (or current) unspecified 31202 Undersocialized conduct disorder aggressive type moderate degree Bipolar I disorder most recent episode (or current) manic severe without mention of 29643 Diagnosis Outpatient planned description V703 Other general medical examination for administrative purposes 29690 Unspecified episodic mood disorder V5883 Encounter for therapeutic drug monitoring V5869 Long-term (current) use of other medications 311 Depressive disorder not elsewhere classified 31202 Undersocialized conduct disorder aggressive type moderate degree 29680 Bipolar disorder unspecified 29640 Bipolar I disorder most recent episode (or current) manic unspecified 78039 Other convulsions V6751 Follow-up examination following completed treatment with high-risk medication not elsewhere classified 31381 Oppositional defiant disorder 31401 Attention deficit disorder of childhood with hyperactivity 30981 Posttraumatic stress disorder 2989 Unspecified psychosis 34590 Epilepsy unspecified without intractable epilepsy 3129 Unspecified disturbance of conduct 3009 Unspecified nonpsychotic mental disorder 29633 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 31282 Conduct disorder adolescent onset type 29660 Bipolar I disorder most recent episode (or current) mixed unspecified
88102 Open wound of wrist without complication 31389 Other emotional disturbances of childhood or adolescence V6284 Suicidal ideation 30000 Anxiety state unspecified 29663 Bipolar I disorder most recent episode (or current) mixed severe without mention of 9693 Poisoning by other antipsychotics neuroleptics and major tranquilizers 47400 Chronic tonsillitis 9779 Poisoning by unspecified drug or medicinal substance V715 Observation following alleged rape or seduction 9630 Poisoning by antiallergic and antiemetic drugs 78097 Altered mental status 49392 Asthma unspecified with (acute) exacerbation V202 Routine infant or child health check V700 Routine general medical examination at a health care facility 99553 Child sexual abuse 30500 Nondependent alcohol abuse unspecified drinking behavior 78093 Memory loss 47402 Chronic tonsillitis and adenoiditis 78009 Alteration of consciousness other 49390 Asthma unspecified 9663 Poisoning by other and unspecified anticonvulsants 7804 Dizziness and giddiness 34510 Generalized convulsive epilepsy without intractable epilepsy 29650 Bipolar I disorder most recent episode (or current) depressed unspecified 29623 Major depressive affective disorder single episode severe degree without psychotic behavior Diagnosis Inpatient planned description 29690 Unspecified episodic mood disorder 29680 Bipolar disorder unspecified 31401 Attention deficit disorder of childhood with hyperactivity 30981 Posttraumatic stress disorder 29633 Major depressive affective disorder recurrent episode severe degree without 2989 Unspecified psychosis 29980 Other specified pervasive developmental disorders current or active state 29634 Major depressive affective disorder recurrent episode severe degree specified as with 29900 Autistic disorder current or active state 31389 Other emotional disturbances of childhood or adolescence 29663 Bipolar I disorder most recent episode (or current) mixed severe without mention of
29660 Bipolar I disorder most recent episode (or current) mixed unspecified 29664 Bipolar I disorder most recent episode (or current) mixed severe specified as with 31381 Oppositional defiant disorder 29630 Major depressive affective disorder recurrent episode unspecified degree 29570 Schizoaffective disorder unspecified state 29650 Bipolar I disorder most recent episode (or current) depressed unspecified 311 Depressive disorder not elsewhere classified 31234 Intermittent explosive disorder 31281 Conduct disorder childhood onset type 29654 Bipolar I disorder most recent episode (or current) depressed severe specified as with 29623 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 29990 Unspecified pervasive developmental disorders current or active state 29653 Bipolar I disorder most recent episode (or current) depressed severe without mention of 29661 Bipolar I disorder most recent episode (or current) mixed mild 29530 Paranoid type schizophrenia unspecified state 29620 Major depressive affective disorder single episode unspecified degree 3129 Unspecified disturbance of conduct 29689 Other and unspecified bipolar disorder other 29631 Major depressive affective disorder recurrent episode mild degree 29643 Bipolar I disorder most recent episode (or current) manic severe without mention of 29652 Bipolar I disorder most recent episode (or current) depressed moderate 29644 Bipolar I disorder most recent episode (or current) manic severe specified as with 29632 Major depressive affective disorder recurrent episode moderate degree 9654 Poisoning by aromatic analgesics not elsewhere classified 29699 Other specified episodic mood disorder 30000 Anxiety state unspecified 29622 Major depressive affective disorder single episode moderate degree 31282 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 29640 Bipolar I disorder most recent episode (or current) manic unspecified 30500 Nondependent alcohol abuse unspecified drinking behavior 49302 Extrinsic asthma with (acute) exacerbation
29564 Schizophrenic disorders residual type chronic state with acute exacerbation