This confuses me, as won't billing the above codes means that the benefits would automatically fall into the "mental Health" category of benefits?What are the codes for office based, private practice "substance abuse" treatment?This is in New York State, in case that is relevant.
You would bill whatever services/dx your given.. I'm not understanding your question really.
Linda - I think your response to bill whatever services/dx your given.. contradicts both the reality of billing and previous comments you have made.
One of our clients writes down what he did and leaves it to his staff to find the correct code(s).
Also - in previous discussions, you have presented convincing evidence that billers can be prosecuted for the fraud perpetrated by the provider because "the billers should have known better" or "the billers should have recognized the fraud being perpetrated by the provider". The underlying principle to both of those statements is that billers should be informed enough to recognize when a provider is not providing correct service/dx/cpt information to the biller. Again, billers being informed enough to catch errors (intentional or purposeful) perpetrated by the provider requires that billers have more than a passing acquaintance with coding.
I think the confusion is in calling to check benefits. Wondering why you would check benefits for mental health AND substance abuse. Thinking they are the same?
rdmoore-I know that this is the case with some insurers, that they apply the benefit in regards to the dx code, but I am not sure that they all do? I am trying to discern this, and in my experience the phone reps at the ins companies are not knowledgeable or helpful in these cases. In my preliminary research, the provider and I found some HCPCS codes for substance abuse tx, but I think those codes cannot be used with POS 11?