Wiki DX CODES F31.9 AND F33.1

[Pkirsch1]

My claims are being denied from Humana Medicare because they don't like F31.9 and F33.1 together.
My provider has been using these dx codes together for years with another Insurance.
Can she just use the F31.9 without the F33.1?

Thank you!

 

[sls314]

My claims are being denied from Humana Medicare because they don't like F31.9 and F33.1 together.
My provider has been using these dx codes together for years with another Insurance.
Can she just use the F31.9 without the F33.1?

Thank you!

Those codes actually should be denied when billed together - there is an Excludes1 note between F33.- and F31.-

Payers are becoming more savvy with coding guidelines, and I'd expect you'll start to see more denials for more payers if your provider continues billing those codes on the same claim. More payers will likely start denying those claims as they implement edits for invalid diagnosis coding.

It would be the provider's judgment whether F31.9 or F33.1 would be more appropriate for the specific patient, but codes in F33.- and F31.- should not be billed together.

 

[Pkirsch1]

Thank you for help Susan.