Medical Billing Forum
Coding => Coding => : KathyG February 28, 2013, 04:17:55 PM
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Could anyone help me with the proper codes to use for drug and alcohol related services in an office setting? DX is 305.00. I need advice on the procedure code for the initial evaluation, individual sessions (>45 mins.), and for group sessions with peers. I have not billed for substance abuse before and just used the usual behavioral health codes (now 90791, 90834, and 90853) for this current claim with the DX of 305.00 (Non-Dependent Alcohol Abuse). Aetna is not recognizing services as coded as being related to substance abuse, which reduces the co-payment of $10 to $0 for the patient if the treatment is drug/alchohol related. Thanks!
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Not sure if this helps, but we have up to 100 suboxone patients at any time. I bill 90791 for initial visits with 304.00 as the diagnosis code. For office visits, we typically bill something like 99213 (depending on the exact nature/complexity of visit) with the same diagnosis code.
The 90853 group therapy code remains the same.
This is for treatment of opiate addiction with a prescription drug, though, so it is perhaps similar but different.
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Thanks, James!
Sounds like we are treating this the same way, which is good to know. I assume you are getting paid...so maybe it was just a "glitch" and the claims will be paid if I appeal. I was told by Aetna that those CPT codes are not picking up the substance abuse services, but I would think that the DX would indicate substance abuse treatment.
Take care...
Kathy G. :)
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We have an Intensive Outpatient Program that we bill using two different codes - 90899 and H0015. Some insurance companies pay with no problems; others we are still "fighting" with because they authorize H0015 and then will not pay. As far as we can find, there is NO CODE for IOP. If anyone has a different code please let me know. Thanks.