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. I have tried submitting this to insurance companies and they say they do not reimburse for this code. That it is too broad and to be more specific. Is there a better diagnosis code that I can present to the counselor to see if it will work?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.
Second, our agency has two departments, Mental Health and Substance Abuse. Some clients are needed to be seen by both departments. To make it less of a burden we would like to schedule the clients on the same day. We bill with one NPI for the agency. We run into problems billing for this. I have tried using Modifier 59 for a distinct procedural service. I have also tried Modifier XE, Separate Encounter and XP, Separate Practitioner. Neither have worked. Is there another Modifier I could be using. We are trying to avoid getting credentialed with another NPI.
Most insurance carriers do not pay for two separate counseling sessions on the same day even if they are with separate providers. You could try to get authorization prior to seeing the patient or else the patient will have to come on separate days. I know it's a pain but if the provider wants to be reimbursed then the patient will have to come in separately.
The insurance carriers won't reimburse that code because many auto carriers or health plans will not pay for any services related to drug or alcohol related illness/injury. Unfortunately you have to be more specific with the diagnosis. Also court mandated services are often not payable either by insurance as well. I wouldn't try adding modifiers because the doctor is assigning incorrect and possibly fraudulent codes since she may know the carriers are not going to be paying for it. I would try and get her to understand this and assign proper codes. Patient may be responsible for charges.
Quote from: TurningPoint on November 28, 2017, 12:06:33 PMTake a look at icd Z13.89 to see if that applies. It is encounter for screening for other disorder. But that is a broad dx as well. Thank you for that diagnosis. I will present it to the counselor to see if it fits her evaluation.
Take a look at icd Z13.89 to see if that applies. It is encounter for screening for other disorder. But that is a broad dx as well.
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
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.
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.