RFI Browser

Back  RFI # 831: Residential Psych Treatment

Formal vs. Informal Help Informal Formal

Submitter

Diana Sokolowski

Description

Residential Psychiatric Treatment (EB03 code RT) has been tentatively defined as "Services and care related to treatment of patients or clients receive treatment for their particular physical, mental, or emotional condition needs at their home provided by a physician or other healthcare provider" by the BCBSA. Within our contracts, "Residential" is also used when referring to residential facility care.

Is the intended definition for EB03 code RT limited to a home environment or does it/can it also include residential facilities in its intended usage under guide 005010X279?

Response

Definitions do not exist for Service Type Codes, however in many cases the Service Type Code itself should be descriptive enough for most purposes. Since definitions do not currently exist for these codes, only X12 can add definitions to these codes through the X12 Standards process.

The intended use of code RT Residential Psychiatric Treatment is Psychiatric Treatment in a Residential facility. It was not intended to be used for services rendered at the patient’s home.

A more appropriate representation for the definition listed in the request would be to use Service Type Code A4 (Psychiatric) in combination with a Facility Type Code of 12 (Home).

Recommendation

One of the challenges with the existing code list is that many of the codes are not service types at all, rather they are places of service or are associated with a place of service which are more appropriately defined by using the Facility Type Codes available in the transaction. Future versions of the service type code list will likely remove all service type codes that can be represented by a Facility Type Code.

X12, and in particular X12N/TG2/WG1 (Health Care Eligibility) and X12N/TG2/WG10 (Health Services Review) have undertaken the effort to make the Service Type Code an external code list (similar to the Claim Adjustment Reason Codes for example) and the list is being revised with one of the goals being to add definitions to those codes that may lead to multiple interpretations. These revisions are intended for use with future versions of the 270/271 and 278 transactions (beyond 5010).
Submission 8/10/2009
Status Date 10/5/2009
Status F - Final
Primary References
Document 005010X279
Section2
Page297
Set ID271
Table2
Loop2110C
Segment IDEB
Element Position03
Code ValueRT