Billing question for practicing providers

Started by Cataclysmic
Get help with your application

Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.

Browse articles Compare schools My application plan Read Interview Feedback
Practice for interviews Ask an Advisor
C

Cataclysmic

New Member
5+ Year Member
Hi there, I just had a quick question for practicing providers. I was told by my billing department that I cannot solely bill for mental health, for example depression, anxiety, ADD without a “medical diagnosis.“ I’ve never heard that throughout residency, having build 99213 and 99214s solely based on these diagnoses in the past and never heard any problems. I am told that I need to add “medical diagnosis “like blood pressure elevation, constipation, etc. in order for them to qualify. The billing department stated that they actually get reimbursed less for 99213/4 if there’s only mental health diagnosis is attached to the encounter. Is this true? I am not using therapy codes specific for mental health either!
 
That may have been true many years ago, but no payer should still be doing that. If they are, you should drop them.
 
There is a workaround, however, which I employed in the old days. Most patients with common psychiatric issues like depression and/or anxiety also have physical (somatic) symptoms (e.g., fatigue, insomnia, headaches, reflux/heartburn, abdominal pain, bowel changes, appetite changes, weight gain/loss, loss of libido, heart palpitations, etc.) If you code any of these "medical" diagnoses before any mental health diagnoses, your claim should go through. You won't be doing anything unethical or illegal, either. You don't make the rules. You're just playing the game.

If you have a mental health claim that's denied, you should be able to re-submit it along with the codes for any associated somatic symptoms that were documented in your original note. Don't change your documentation after the fact, however. That would be fraudulent.
 
Blue Dog said:
There is a workaround, however, which I employed in the old days. Most patients with common psychiatric issues like depression and/or anxiety also have physical (somatic) symptoms (e.g., fatigue, insomnia, headaches, reflux/heartburn, abdominal pain, bowel changes, appetite changes, weight gain/loss, loss of libido, heart palpitations, etc.) If you code any of these "medical" diagnoses before any mental health diagnoses, your claim should go through. You won't be doing anything unethical or illegal, either. You don't make the rules. You're just playing the game.

If you have a mental health claim that's denied, you should be able to re-submit it along with the codes for any associated somatic symptoms that were documented in your original note. Don't change your documentation after the fact, however. That would be fraudulent.
Click to expand...


So: if there is a chief complaint, HPI, ROS, PE that has an appropriate level of documentation/history... one should be able to bill 99213-99215 if using ICD10 codes for depression, anxiety, opiate dependency, etc?
 
Cataclysmic said:
So: if there is a chief complaint, HPI, ROS, PE that has an appropriate level of documentation/history... one should be able to bill 99213-99215 if using ICD10 codes for depression, anxiety, opiate dependency, etc?
Click to expand...

I haven't had any trouble with it in years.
 
I'm not an expert in billing/coding but I'd consider myself above average. I'm not aware that this is a thing. May be related to specific insurance contracts, but you shouldn't be adjusting your ways based upon any one patient's insurance.
 
You must log in or register to reply here.