IDC-10 payment information

rmooney1114

Networker
Messages
45
Location
Monson, MA
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0
Hello, I was hoping someone could lead me in the right direction. I am looking for a way to find out if certain diagnosis codes are covered/reimbursed by certain payers in our area. I am a coder/auditor/risk adjustment coder, but a lot of providers always ask me if certain dx codes are actually reimbursable, and I know this is technically a billing question, but I wasn't sure if there was a certain website or something that has such information. Specially I am looking to see if the new travel counseling dx code effective 10/1/2019 (Z71.84), is reimbursable by any insurance as a primary listed diagnosis code.

Thank you
Ruth Mooney CPC, CPMA, CRC
 

Pam Brooks

True Blue
Local Chapter Officer
NAB Member
Messages
2,096
Location
South Berwick, ME
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0
Generally, you have to reach out to the individual payers for their payment policies. Sometimes the policies are on line, and other times you'll get the information based on what's indicated as being 'not covered'. Occasionally, the payment policies will list both covered CPT and ICD-10 codes (CMS does this), but each payer is different. The best contacts you can make in this industry are the assigned provider relations people for each of your biggest payers. I'm not talking about the ones you reach when you call the 1-800 number, but the managers for provider relations. Usually your state MGMA (Medical Group Management Association) has a list.
 
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