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SMI Codes

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I have a speech therapist that has been told that SMI codes can be used as diagnosis codes for speech therapy.  It was my understanding that SMI codes are for severe mental illness.  I believe she has been led to believe that she can use these codes and that reimbursement and claims processing is completely different when these codes are used. She keeps talking about an SMI code book.  Does anybody have any experience with SMI codes? ???  I am confused how an SMI code would even be appropriate for speech therapy. 

SED and SMI diagnosis codes can ONLY be used for those with Serious Emotional disorders and Serious Mental Illness IN WHICH the disorders effect the physical wellness:

A critical focus of the ADHS/DBHS service delivery system is the effective and efficient delivery of behavioral health services to persons who have special needs due to the serious nature of their behavioral health disorder. One such group is persons with serious mental illness (SMI). Without receipt of appropriate care, these persons are at high risk for further deterioration of their physical and mental condition, increased hospitalizations and potential homelessness and incarceration.

I also believe that this type of care management with SMI or SED diagnosis has to be established with the carrier first and treatment must be coordinated with the mental health professional and other healthcare providers. These are usually case management files setup with the carriers.

So my answer is "no" as she is probably looking to use them "routinely" and that's not what they are for.

One of the kids has fetal alcohol syndrome. 760.71.  Would that be considered an SMI code? I figured you would know the answer to this question!  lol!

I would check with the carrier, I'm sure it's going to depend on age.. and many other variables, if it's to be an SMI code the child will have a case setup as case management.

Thanks Linda!


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