Medical Billing Forum

Coding => Coding => Topic started by: dans169 on August 20, 2015, 09:25:19 AM

Title: ICD 10, reporting a medical and mental health dx on the same claim
Post by: dans169 on August 20, 2015, 09:25:19 AM

This question/s is related to ICD – 10 and manifestation DX codes that require more than one DX be reported on the claims.

For certain “manifestation codes”, the ICD 10 book states:

“code first / use additional code: the etiology/manifestation code requires the underlying condition be sequenced first, followed by the manifestation. In these situations codes with “in diseases classifies elsewhere” in the code description are never permitted as a first cited or principal diagnose code and must be sequenced following the underlying condition code.”

Our office is neuropsych, some of our insurance contracts are medical, some are mental health depending on how the insurance company classifies the specialty and how it extends contracts.

Let’s say someone is seen for psychotherapy and the dx of  (ICD-9, 316….ICD-10, F54) is used, but the underlying condition that needs to be coded first is a medical condition.

If we follow the ICD-10 requirement and code the medical dx first and the mental health “manifestation” dx second will this cause issues when the claims are being processed?

For example, will they process the claim as out of network or deny it entirely since it is a mental health CPT and a medical dx is included with the mental health dx?

As always, thanks for your help!

Title: Re: ICD 10, reporting a medical and mental health dx on the same claim
Post by: Michele on August 30, 2015, 04:11:28 PM
This is a tough one.  There are going to be bumps that have to be worked out with the switch to ICD10 and I think you've just described one such bug.  I'm afraid there is no easy answer.  Each insurance carrier may also handle the situation described differently too.  I wish I could give you a simple "do this" answer but there isn't one.  :(