Wiki Family practice/Medicaid and ADHD patients

[tolsen]

Good morning.
I was wondering if someone could guide me through how to code for ADHD patients and medicaid. I am billing New/Est patient E&M codes with the dx. code of F90.9 but we are getting denials from medicaid stating "Payer indicates that this service is not covered or allowed". Am I coding this correctly? Can anyone advise me on what we should do?
Thank you.

 

[rsg7676]

ADHD Patients

This could be that the diagnosis is unspecified and they might want a more detailed diagnosis, or this could also be the patients age since this code is for children or adolescence. In my previous experience working with medicaid we would get the E/M services paid with the ADHD diganosis but we would stay clear of the unspecified diagnosis. Hope this helps!

 

[tolsen]

Thank you so much for your help.

 

[tolsen]

I am still getting my claims returned to me denied. I am using the most descriptive diagnosis code. HELP??

 

[Tami_F]

Have you tried using Z51.81 (Encounter for therapeutic drug level monitoring) as the primary code for these kids? That's generally what we do when the pt is primarily being seen for management of ADHD meds.