jlwilson
Networker
Hi everyone,
I'm running into a sequencing issue with mood disorder due to TBI for payers. Specifically, they do not like the sequela code as a first listed code. Does anyone have any practical real-world experience with this? I've reviewed the Official Coding Guidelines pretty exhaustively and can't find a Coding Clinic that addresses this scenario. Specifically. briefly, the sequela S code shouldn't be first listed however the F codes for mood disorders due to conditions expressly state code first underlying condition. There is this exception stated in the OCG Section B and I think this applies but am hoping someone out there knows more than I do. If you've encountered this, how do you resolve? Do you keep the sequencing with S code followed by F code and cite this? Does that lead to any other denials for billing BH services without an F code primary? Or some other action? Any help is appreciated.
Conditions as stated by provider:
Major Neurocognitive Disorder due to Traumatic Brain Injury with Behavioral Disturbance
Mood Disorder due to Traumatic Brain Injury
S06.9XAS - Unspecified intracranial injury with loss of consciousness status unknown, sequela [Active]
General convention states sequence manifestation first
BUT
F02.818 Dementia in other diseases classified elsewhere, unspecified severity, with other behavioral disturbance
F06.31 - Mood disorder due to known physiological condition, unspecified [Active]
Both state - Code first the underlying physiological condition
I'm running into a sequencing issue with mood disorder due to TBI for payers. Specifically, they do not like the sequela code as a first listed code. Does anyone have any practical real-world experience with this? I've reviewed the Official Coding Guidelines pretty exhaustively and can't find a Coding Clinic that addresses this scenario. Specifically. briefly, the sequela S code shouldn't be first listed however the F codes for mood disorders due to conditions expressly state code first underlying condition. There is this exception stated in the OCG Section B and I think this applies but am hoping someone out there knows more than I do. If you've encountered this, how do you resolve? Do you keep the sequencing with S code followed by F code and cite this? Does that lead to any other denials for billing BH services without an F code primary? Or some other action? Any help is appreciated.
Conditions as stated by provider:
Major Neurocognitive Disorder due to Traumatic Brain Injury with Behavioral Disturbance
Mood Disorder due to Traumatic Brain Injury
S06.9XAS - Unspecified intracranial injury with loss of consciousness status unknown, sequela [Active]
General convention states sequence manifestation first
BUT
F02.818 Dementia in other diseases classified elsewhere, unspecified severity, with other behavioral disturbance
F06.31 - Mood disorder due to known physiological condition, unspecified [Active]
Both state - Code first the underlying physiological condition
