Billing and Coding: Psychiatric Inpatient Hospitalization

Medicare covers inpatient psychiatric hospitalization when a physician certifies at admission that services are medically necessary for treatment expected to improve the patient's condition or for diagnostic study and when the patient is receiving daily active treatment supervised by IPF personnel. Documentation must include a timely physician-certified initial psychiatric evaluation (within 24–60 hours), physician recertifications (first by day 12, thereafter at least every 30 days), complete medical records, signed notes, and applicable ABN documentation (CMS-R-131) and modifiers; claims lacking a valid ICD-10-CM diagnosis or non-compliant with NCCI/OPPS edits may be returned or denied.

"Physician certification at admission (or as soon as reasonably practicable) that inpatient psychiatric hospitalization is medically necessary for treatment expected to improve the patient's conditi..."