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Mental Hlth Dx

NESmith

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Plant City, FL
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I hope this is not a dumb question and if it is I am sorry but I have to ask.

A Neurologist bills a E/M using a Mental Hlth Dx(Generalized Anxiety Disorder)the patient's Medical Insurance is denying the claim stating the claim needs to be sent the the patient's Behavioral Hlth carrier and the Behavioral Hlth carrier is stating no this needs to be billed to the patient's Health Iinsurance, so now for my question. Is there ever a circumstance, in which the Behavioral Hlth carrier would be the correct payer for certain Neurology services, or should the Neurology claim ever be billed and/or paid by Behavioral Hlth benefits?it's very confusing when trying to appeal a claim and you truly do not know who the responsible party is suppose to be when both carriers are stating that it's the other carrier's responsibility.

Thanks for you help in this matter
 

hewitt

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Not a stupid question at all.... The confusion is because the medical insurance is expecting to see a diagnosis relating to a systemic illness or "sick" diagnosis, and the behavioral health carrier a psychiatric related CPT. The CPT and diagnosis are not normally linked together. Is there a "sick" diagnosis you can link to the E/M? If not, can you bill a psychiatric CPT with the diagnosis of anxiety?
 

NESmith

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Plant City, FL
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Perfect answer. This was kinda the way I was looking at it but sometimes when you look to long then the answer becomes more than it is. So in your opinion you could code the signs and symptoms the patient was having at the time of the visit?
 

hewitt

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I would advise not to code signs and symptoms.... Is there another more primary codition, maybe psychiatric codition, causing the anxiety? What is the chief complaint? Why did the patient come in?
 

NESmith

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CC was dizziness and concentration issues. Patient complains while carrying out any type of task either one requiring a lot of concentration or menial tasks at home, or while watching the children that he needs to focus, he looses track of time, easily disoriented, unable to focus. Associated with this complaint is the sensation of lightheadedness. No vertigo,headaches, or ringing in his ears. He has noticed intermittently with these spells, blurry vision, but no vision loss.
 

hewitt

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If the physician does not diagnose a physical cause for the dizziness and concentration issues, then you have to code what is in the note (as you already know :)).... Per the description above, anxiety is not a good primary diagnosis. Maybe 780.4, 780.97, to be used with the E/M? What do you think?
 
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