snwhite0730
Contributor
Hello Coders!
I am hoping someone can assist me. I work the lab denials for a large providers office. They see patients for chronic pain medications and run UDS at each visit. I have been getting denials and I cannot figure out why, or how I should be coding these out for billing. I was using Z51.81 with Z79.891 but the senior coder in the office says this isn't correct and I should list the conditions the patients are receiving care for ie M54. 50 with Z79.891. I also checked the NCD/LCD from CMS which says:
Group 1 Paragraph
For monitoring of patient compliance in a drug treatment program, use diagnosis code Z03.89 as the primary diagnosis and the specific drug dependence diagnosis as the secondary diagnosis.
For the monitoring of patients on methadone maintenance and chronic pain patients with opioid dependence use diagnosis code Z79.891, suspected of abusing other illicit drugs, use diagnosis code Z79.899.
G0480, G0481, G0482, G0483, G0659, 80305, 80306, 80307.
Diagnosis codes must be coded to the highest level of specificity.
For codes in the table below that require a 7th character, letter A initial encounter, D subsequent encounter or S sequela may be used.
Most of our patients have a diagnosis of F11.90 Opiate use, not dependence and the NCD says opioid dependence. How does anyone out there bill out their UDS and get them covered for medicare patients? I am very confused since I was billing with just the Z codes (senior coder says this is not the correct way to code the visits) because the encounter is for medication management (Pain management) and the patients are only seen for refills. Any lab coders out there that can offer me some guidance? I appreciate any type of feed back I can get. Thank you!
I am hoping someone can assist me. I work the lab denials for a large providers office. They see patients for chronic pain medications and run UDS at each visit. I have been getting denials and I cannot figure out why, or how I should be coding these out for billing. I was using Z51.81 with Z79.891 but the senior coder in the office says this isn't correct and I should list the conditions the patients are receiving care for ie M54. 50 with Z79.891. I also checked the NCD/LCD from CMS which says:
Group 1
(278 Codes)Group 1 Paragraph
For monitoring of patient compliance in a drug treatment program, use diagnosis code Z03.89 as the primary diagnosis and the specific drug dependence diagnosis as the secondary diagnosis.
For the monitoring of patients on methadone maintenance and chronic pain patients with opioid dependence use diagnosis code Z79.891, suspected of abusing other illicit drugs, use diagnosis code Z79.899.
G0480, G0481, G0482, G0483, G0659, 80305, 80306, 80307.
Diagnosis codes must be coded to the highest level of specificity.
For codes in the table below that require a 7th character, letter A initial encounter, D subsequent encounter or S sequela may be used.
Most of our patients have a diagnosis of F11.90 Opiate use, not dependence and the NCD says opioid dependence. How does anyone out there bill out their UDS and get them covered for medicare patients? I am very confused since I was billing with just the Z codes (senior coder says this is not the correct way to code the visits) because the encounter is for medication management (Pain management) and the patients are only seen for refills. Any lab coders out there that can offer me some guidance? I appreciate any type of feed back I can get. Thank you!