Q&A: Inpatient psych

Q: Does anyone review inpatient psyche as part of their workflow? We are being asked to explore this and have done a small sample of reviews. We are finding minimal outcomes of any kind, but we do not really understand how these are paid (for Medicare). Does anyone have any experience with this they can share?

A: Some facilities may choose to not review for inpatient psych DRGs as they tend to be unaffected, without any changes due to secondary diagnoses.

If you do choose to review for these DRGs, consider reviewing them for inpatient psychiatry, geriatric psychiatry inpatient, and adolescent psychiatry. Note that these reviews are not billed by DRG, but by days. That being said, reviewing for inpatient psych for adult and adolescent psychiatry can make a large difference.

Look for chronic conditions, nutrition status, withdrawal, medication induced encephalopathy, hallucinations in non-psychotic cases, and specificity of major depressive disorder. For more information, review the CMS FY 2021 Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) and Special Requirements for Psychiatric Hospitals for Fiscal Year Beginning October 1, 2020 (FY 2021).

Editor’s note: This question and answer were adapted from a thread on the ACDIS Forum. To learn more about participating on the Forum, click here.