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Inpatient Visits

Revised: 10-04-2013

MHCP covers inpatient visits.

Eligible Providers

  • • Clinical Nurse Specialist-Mental Health (CNS-MH)
  • • Licensed Psychologist (LP) (with a physician’s order)
  • • Physicians
  • • Psychiatric Nurse Practitioner (NP)
  • • Psychiatrists
  • Physician assistants (PA) are eligible to provide evaluation and management services, consistent with their authorized scope of practice, in an inpatient hospital setting when supervised by an MHCP enrolled physician or psychiatrist. A PA may not provide psychotherapy, diagnostic assessment, or clinical supervision.

    Eligible Recipients

    Hospitalized MHCP enrolled recipients

    Covered Services

  • • MHCP covers hospital evaluation and management (E/M) services and psychiatric services, when billed according to the service requirements
  • • A medical physician may provide medical care during the same day that a psychiatrist, CNS-MH, or psychiatric NP provides mental health services
  • • When a recipient is admitted to an inpatient hospital for medical reasons, psychiatric care must be ordered by a physician or psychiatrist
  • • MHCP only covers one visit per day, of the same service, by the same physician
  • Billing

  • • Use the MN–ITS 837P to bill for physician and non-physician services
  • • Enter the treating provider NPI number on each claim line
  • • Enter place of service code 21 for all visits in an inpatient setting
  • • Use the appropriate level procedure codes for all services
  • • Use the appropriate modifier when billing for interns or residents
  • When a recipient is admitted to an inpatient hospital, only a psychiatrist, CNS-MH, or psychiatric NP may bill for inpatient visits and receive the professional fees (not included in the facility payment).

    In the inpatient setting, MHCP will reimburse the NP or CNS services if the individual is not employed by the hospital or included in the hospital cost report that is currently used for hospital rate setting. The cost report used for the current rates is always from a few years prior to the current year.

    See Physician Consultation, Evaluation and Management for covered service policy when a psychiatrist requests a medical physician to assume responsibility for managing a recipient’s non-psychiatric medical care.

    Use the following table for billing services with date of service on or after January 1, 2013:

    Procedure Code

    Brief Description

    Service Limitations

    99221—99223

    Inpatient Hospital Care

  • • Psychiatrist is admitting physician for initial hospital visit or Medical physician performs a physical exam as part of admission process
  • • Only admitting physician uses initial hospital care code
  • • Preliminary diagnosis and plan of care are part of the initial visit
  • 99231—99233

    Subsequent Hospital Care

    Medical physician manages recipient’s non-psychiatric medical care after initial inpatient hospital consultation

    99251—99255

    Initial inpatient consultation

    A physician requests a consultation.
    Must see the patient face to face.


    Refer to the Psychotherapy section when inpatient Psychotherapy services are provided.

    Refer to 2012 Inpatient Visits for information about billing services with date of service prior to January 1, 2013.

    Definitions

    E/M: Evaluation and Management (EM), codes are used to report services provided in a physician's office or outpatient or other ambulatory facility or services provided to an individual who is an inpatient in a hospital. For mental health services, providers must follow the CPT guidelines when using these codes unless otherwise specified in the coverage text for a mental health service as stated in this chapter.

    Legal References

    MS 256B.0625 sibd., 3

    MS 256B.0625
    subd., 4

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