Advise Needed: Diagnosis assignment

[Jmojica]

A little background: I am the manager of the billing department and the team I met with today is the Mental Health team.

I'm struggling with the clinical team at my full time job. In a meeting today they asked if my billing department can automate the input and termination of the general code F99 which is used for intakes until a permanent DX can be assigned. Before I can say anything the lead of operations said we'll revisit the conversation after reviewing. I wanted to scream NO, we can't. Isn't it the responsibility of a clinician to properly diagnosis a client? That should never be automated right? or am I being unreasonable.

From your professional experiences, what do you think?

[Michele]

I do know from experience that some mental health professionals sometimes need two visits to properly dx a patient.  But the claim should not be submitted without that dx.  So are they asking if the claims can be submitted with the F99?  Honestly I don't think most insurances would cover that dx anyway.  But I see what you are saying as well.  What is their reasoning for wanting  the F99 to automatically populate?

[psychson]

I’ve been working with mental health billing for almost 20 years and YES,  clinical staff, clinician assigned to client/patient should be responsible for inputting a valid diagnosis. As someone already pointed out, it can take 2 or 3 initial assessment to be able to get a diagnosis, however it's no excuse for not having a preliminary one either or not wanting to do the work and use a generic Dx.

There are two questions:
1.   Why do they want it automated ?
2.   Do you need to submit billing as soon as it is entered? What’s the hurry to have a Dx. entered?

You are allowed to bill with a preliminary diagnosis for the first few visits and later have a more comprehensive and "final" diagnosis and change it to bill accordingly.

I would say It's up to your workplace  to "babysit, spoil" clinical staff and add a generic diagnosis or even automat it, but eventually it must be updated and clinicians  are the ones responsible for doing it. Billing staff should refrain from editing anything related to clinical, even it is preventing you from billing. 

You are not saying what type of insurance you are billing, but no matter which one, if Medicare, Medicaid,  HMO’s & PPO’s or even if it’s a state/county/city grant you must follow guidelines for each contract you have and not do things that may penalize you when an audit comes along.

In the end of the day billing should do only what is billing related and no matter how much clinical staff whine about it, it’s not a biller job to input diagnosis. The opposite is also true, it's not a clinician job to submit billing when your billers go on vacation.