snwhite0730
Contributor
Hello Coders,
Once again I am hoping for some clarification. I code for an IP Behavioral health hospital and one of our providers exclusively sees our geriatric patients and by default handles most of our Medicare patients. A large portion of the patients we treat have dementia and are admitting for behaviors like agitation, verbal abuse, mood disorders, etc. Our provider uses Unspecified Psychosis and Major NCD as the final diagnosis on just about all of his discharge summaries. We have started getting denied claims from Triwest when F29 is the primary diagnosis followed by the F03 codes (depending on what behaviors are present).
Our billing office has been told that the codes aren't following Medicare guidelines? Is there a guideline I am missing when coding for dementia?
I have been wondering with regard to the F03 section specifically, since it is Unspecified dementia and not a manifestation code like F01 and F02 with a code first guidelines, can it be the Primary diagnosis?
Is there a better code to use for the psychosis? Should I be using a combination code for the dementia?
I feel like this is really about how the provider won't tie the psychosis to the dementia and uses Unspecified Psychosis but I really am at a loss. Any help is appreciated
.
Once again I am hoping for some clarification. I code for an IP Behavioral health hospital and one of our providers exclusively sees our geriatric patients and by default handles most of our Medicare patients. A large portion of the patients we treat have dementia and are admitting for behaviors like agitation, verbal abuse, mood disorders, etc. Our provider uses Unspecified Psychosis and Major NCD as the final diagnosis on just about all of his discharge summaries. We have started getting denied claims from Triwest when F29 is the primary diagnosis followed by the F03 codes (depending on what behaviors are present).
Our billing office has been told that the codes aren't following Medicare guidelines? Is there a guideline I am missing when coding for dementia?
I have been wondering with regard to the F03 section specifically, since it is Unspecified dementia and not a manifestation code like F01 and F02 with a code first guidelines, can it be the Primary diagnosis?
Is there a better code to use for the psychosis? Should I be using a combination code for the dementia?
I feel like this is really about how the provider won't tie the psychosis to the dementia and uses Unspecified Psychosis but I really am at a loss. Any help is appreciated
.