Wiki F90.0 & F98.8 not covered by Alaska Medicaid

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oskolkoff

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Ninilchik, AK
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Alaska Medicaid is denying F98.8 and F90.0 for adult patients. They only recognize them for patient age 0 to 17 years, 11 months. My office has copied the page out of ICD 10 and included it with our appeal. Book states " Behavioral and emotional disorders with the onset usually occurring in childhood and adolescence. Codes within categories F90.0 and F98.8 may be used regardless of the age of a patient. These disorders generally have onset within the childhood or adolescent years, but may continue throughout life or not be diagnosed until adulthood". Is anyone else having this issue? Any ideas how to get these claims paid?
Thanks for the help,
Jennifer
 
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Hi Oskolkoff,:)
Yes those dx need to be used but with more dx are descriptive with pt. problems. Dx F90 has differ levels of ADHD in dx of F90.0-F90.9. Also states to use with a child or adolscent ..thus age of patient does count. The payer probably has algorithm of an edit built in to deny if patient is of adult age. Adolescent ages are 10 years to 19 years is the standard. The dx codes of R44 to R46 help describes more mental health behaviors/symptoms the provider can have in documentation or list in assessment. Also add the Z codes at the end of claim(example dx Z62 to Z63), to give more details if supported. Naturally the MH provider should use the dx F32, F41, F06,F43, Etc. in conjunction with the patient s documented illness. Maybe you can have the Mh providers actual look in that section of the ICD10 manual.
Well hope I helped you a little bit more.:)(y)
Lady T
 
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What are the procedures those diagnoses are linked to? What are you trying to bill? It may not matter if the ICD-10 can be reported for any age, it matters that they may not cover adult (over 21 usually) autism treatment depending on what you are trying to bill.

Recipient Eligibility for Autism Services Recipients receiving autism services must be under 21 years of age

 
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amyjph said:
What are the procedures those diagnoses are linked to? What are you trying to bill? It may not matter if the ICD-10 can be reported for any age, it matters that they may not cover adult (over 21 usually) autism treatment depending on what you are trying to bill.

Recipient Eligibility for Autism Services Recipients receiving autism services must be under 21 years of age

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I agree that this sounds more like it could possibly be a benefit issue. There may be an age limit for the services that were billed.

I am not familiar with Alaska Medicaid specifically, but I know that there are states that limit certain benefits by age range.

What services were performed and how old is the patient?
 
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