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Wiki Diagnosis coding with H&B CPTs
- Thread starter lb8494
- Start date
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mitchellde
True Blue
Can you be more specific as to what diagnosis codes you are currently using that are being denied?
Response
Unfortunately, the providers are not consistent. Some use only medical (non-F) codes, some use only behavioral health codes (F codes), some use medical primary/BH secondary, some use BH primary/medical secondary. They each have a rationale for their method, but no one can tell me where they got that direction. There is not an obvious pattern emerging in the denials.
I realize it is still a very vague reply, but hopefully gives a general idea.
Unfortunately, the providers are not consistent. Some use only medical (non-F) codes, some use only behavioral health codes (F codes), some use medical primary/BH secondary, some use BH primary/medical secondary. They each have a rationale for their method, but no one can tell me where they got that direction. There is not an obvious pattern emerging in the denials.
I realize it is still a very vague reply, but hopefully gives a general idea.
mitchellde
True Blue
Providers are not Coders and generally are picking codes from a cheat sheet they have been given. There are coding rules regarding which codes may be first listed and codes that may not be coded together and codes that require certain secondary codes. Without knowing what the documentation supports verses what they are selecting it is not easy to advise. You should review the chart notes and decide the appropriate codes given the documentation and coding guidelines. If you can provide a specific example I could maybe be of more assistance.