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March 27, 2018

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Medical Coding News Archives

Partial Hospitalization Program Coding

December 23, 2008:

The CPT® book has two groups of psychotherapy services. One group should be used to report office or outpatient therapy, and the other should be used for inpatient, residential, and partial hospitalization services. CPT® codes 90816 through 90829 should only be reported for inpatient, residential, and partial hospitalization program (PHP) services. CPT® instructions direct to report codes 90804 through 90815 for office or hospital outpatient individual psychotherapy services that are not part of PHP services.

CMS had accepted either set of therapy codes for PHP billing; however, in October 2008, CMS instituted edits that prohibit the use of the outpatient therapy codes when billing PHP. If an outpatient code from the series 900804 through 90815 appears on a PHP claim, the claim will be returned to the provider for correction.

CMS has identified several CPT® codes that are inappropriate for billing PHP claims. Effective January 1, 2009, do not report CPT codes 90849 Multi-family group psychotherapy and 90899 Unlisted psychiatric service or procedure when billing PHP claims.

CMS has also eliminated the following two group therapy CPT® codes from use in PHP billing:

90853 Group psychotherapy other than of a multiple-family group
90857 Interactive group psychotherapy

Both CPT® codes 90853 and 90857 would still be used in a non-PHP setting.

These codes are replaced with two new parallel timed HCPCS Level II G codes:

G0410 Group psychotherapy other than of a multiple-family group, in a partial hospitalization setting, approximately 45 to 50 minutes
G0411 Interactive group psychotherapy, in a partial hospitalization setting, approximately 45 to 50 minutes

Effective January 1, 2009, there will be two separate APCs and payment rates for PHP. APC 0172 Level I Partial Hospitalization will apply when there are three services in a PHP day, and APC0173 Level II Partial Hospitalization will apply when there are four or more services in a PHP day.

CMS plans to make changes to the PHP logic portion of the integrated outpatient code editor to deny payment for any PHP days when fewer than three therapeutic services are provided. The current PHP logic results in a suspension of claim for medical review when a claim has fewer than three services provided in a day.

Regina Magnani, RHIT
Clinical Technical Editor

CPT is a registed trademark of the American Medical Association.


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