Marriage counseling has been one of the most difficult things for our office to deal with! We've had many cases in which the patient's insurance company says marriage counseling is covered; however, they aren't able to tell us if the specific diagnosis code we use is covered and that seems to be what matters. One of our doctors has a general rule that if marriage counseling is the primary focus of the therapy, he will use V61.10 as the dx. In my (admittedly limited) experience, insurance companies don't usually cover V-codes such as this (even if the half-witted insurance rep tells you it's covered).
Our doctor made this general rule after reading an article about how "creative billing" constitutes fraud. An example would be: a couple comes in for the stated purpose of marriage counseling; in order to make sure the services are covered, the doctor identifies one partner as the patient and gives him a dx. Although it seems to me this would only be fraud if the doctor was fabricating the diagnosis in order to secure payment from the insurance company.
I'd love to hear about some other (perhaps more insurance-friendly) ways that marriage counseling is billed. We certainly don't want to do anything fraudulent, but I do like to make sure insurance pays when it's supposed to!