“What is the E/M code series that would be considered for an initial visit when seeing a patient in an inpatient, psychiatric facility (POS 56)? Would it be a home code CPT 99341 or 99347?”
Place Of Service code 56 is defined as: PSYCHIATRIC RESIDENTIAL TREATMENT CENTER: A facility or distinct part of a facility for psychiatric care which provides a total 24 hour therapeutically planned and professionally staffed group living and learning environment.
As far as what would be the most appropriate E/M code set for POS 56, you need to take into consideration what exactly is being performed.
E/M codes for Home Services, 99341-99345/99347-99350, might be considered. However, the definition of POS code 12: PATIENT’S HOME: A location other than a hospital or other facility, where the patient receives care in a Private residence certainly negates this E/M code set.
E/M codes for Custodial Care Facilities, 99324-99328/99334-99337, might also be considered. However, the definition of POS code 33: CUSTODIAL CARE FACILITY: A facility that provides room, board, and other personal assistance services, generally on a long term basis, and does not include a medical component negates this E/M code set, as well.
It appears that the most appropriate E/M code set for POS 56 might actually be the Hospital Inpatient Services E/M code set. Why? This is based upon the definition of POS 56: “A FACILITY or DISTINCT PART OF A FACILITY for psychiatric care…” The E/M codes are the following: 99231 – 99233. These are the subsequent Hospital Care E/M codes. The CPT Manual states: “For initial inpatient encounters by physicians other than the admitting physician, see initial inpatient consultation codes (CPTs 99251-99255) or subsequent hospital care codes (CPTs 99231-99233) as appropriate.”
This is my opinion.
Michael G. Warshaw
DPM, CPC
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