Billing > Billing
Z71.9 and 2 Department Billing
PMRNC:
In your first post you mentioned denials because of the vague diagnosis and you mentioned those court ordered for DUI..
--- Quote ---First, we have clients come in for a Substance Abuse evaluation that do not have a diagnosis. For the reason being, either they received a DUI, got in trouble at school for an alcohol related incident, or is just sent in to have an evaluation done. If these clients do not have any "problems", the counselor will give them a Z71.9 Counseling, Unspecified diagnosis
--- End quote ---
--- Quote ---Edit: I just received another one. A school administrator sent a kid in because he was caught with chew. The counselor gave him a Z71.9. I told her it is going to be denied but we're sending it in anyway.
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As you might be seeing these diagnosis are not covered under most insurance policies. What I would do is verify this individually with each carrier to determine coverage. In many cases such as DUI, caught in school and court mandated eval's and counseling the patient should be paying up-front. Trying to get carriers to pay these services by adding modifiers and changing diagnosis codes could indeed be considered fraud.
TurningPoint:
--- Quote from: PMRNC on November 29, 2017, 07:19:08 PM ---
As you might be seeing these diagnosis are not covered under most insurance policies. What I would do is verify this individually with each carrier to determine coverage. In many cases such as DUI, caught in school and court mandated eval's and counseling the patient should be paying up-front. Trying to get carriers to pay these services by adding modifiers and changing diagnosis codes could indeed be considered fraud.
--- End quote ---
Putting the DUI in the first part was just a general statement. We charge cash for DUIs as that is the law. Everything else, if they have insurance we will go with insurance first as that is our bylaws as a nonprofit. There is no point in making the client pay when we are credentialed with the insurance companies to cover our Substance Abuse department. We have more court-mandated cases then walk-ins. We use their insurance and have zero problems getting reimbursed for 99% of these clients. We go with what the provider feels is the best diagnosis. We do not change diagnosis or modifiers "just to get paid." The only claims we have a hard time getting paid on are the clients that have to have evals done that do not have a problem. That was my question. Is there a better diagnosis to use for these cases of the clients that don't have any issues that are sent to us to get an eval done? If that Z71.9 code is the code to use for these clients then that is the one we will stick with and work through the process as long as it takes to get paid. If there is another code that better describes these clients that also gets reimbursed then I will present it to the counselor and see if it fits there eval. Reading up on this code, before I made this post it said the Z71.9 code was used before ICD 10 and that after ICD 10 came out there were more specific diagnoses to replace this. I was wondering if anyone knew of a code that replaced it as Michele pointed out.
There is absolutely no fraud that takes place.
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