Need dx help from experienced mental health coders--please help!!

akj

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I am assigned the coding for the neuropsychologist at our health care organization, and I have very little experience in this area. I'm having an obstacle when it comes to diagnosis coding for CPT 90791. Many of the patients in question are diagnosed with delirium, F05. This dx code requires a primary dx explaining the underlying physiological condition. Often, the provider is uncertain of the causal condition, dictating 'possible etiologies include...'. According to ICD10 guidelines, uncertain wording isn't allowed.

I am wondering if I can use R69 for uncertain morbidity as the primary dx to F05. Do you think this would be appropriate?
 

LynnBrown

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Delirium Unspecified

Delirium unspecified is R41.0. If this diagnosis is denied, then the providers are your facility will need to give you a specific cause of the delirium.
 

akj

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I should have been more specific. Acute delirium due to unknown etiology in ICD10 index shows F05....But F05 in tabular section shows delirium due to known physiological condition and requires code first underlying physiological condition. This isn't always known at the time the patient is seen.
 

CodingKing

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Id still go with R41.0 if you don't have a definitive dx. I don't know what payer you are coding for but according to a Medicare LCD, R41.0 is a covered diagnosis for an eval
 

mitchellde

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I am not sure how you are looking it up but in the Alpha section delirium (acute, subacute) defaults to R41.0, since the provider does not give you a causal condition this would be the appropriate code.
 

CodingKing

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I am not sure how you are looking it up but in the Alpha section delirium (acute, subacute) defaults to R41.0, since the provider does not give you a causal condition this would be the appropriate code.
They went with Delirium > Due To > unknown etiology which brings up F05. I wouldn't have followed "Due to" unless I had a definitive "Due To" reason listed in the medical record.
 

akj

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Coding King--Provider is billing a 90791. R41.0 is not a covered dx in our LCD for this service.

Debra--I tried to PM you, but your mailbox is full.
 

CodingKing

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I find it odd they didn't include it., I see what you mean. Its not listed on LCD L34616. They cover it for hearing loss and fear of flying but not Delirium?
 
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mitchellde

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Apologies for the full inbox.. However covered or not from what you have provided it is still the correct code. You cannot change a code, which in turn changes the diagnosis, just because of a coverage determination. Since the provider is uncertain as to whether there even is an underlying cause then the R41.0 is all you can code. Perhaps the provider should be using a regular E&M level.
 

ckeeney

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I agree that R41.0 is the only possible diagnosis code with the information provided and that you cannot change it based on the LCD. Unfortunately, it looks like this service will not be reimbursed for those patients with Medicare coverage. A further note: unless the neuropsychologist is also an MD/DO/NP or other qualified MEDICAL provider using E/M codes is not an option.
 

akj

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I agree that R41.0 is the only possible diagnosis code with the information provided and that you cannot change it based on the LCD. Unfortunately, it looks like this service will not be reimbursed for those patients with Medicare coverage. A further note: unless the neuropsychologist is also an MD/DO/NP or other qualified MEDICAL provider using E/M codes is not an option.
Thanks for reply. I'm not looking to change the coding to get paid, I just want to make certain I am coding the record correctly. And...my provider is a PhD, so E/Ms aren't an option. ckeeney--is this your field of specialty? If so, could I p.m. you a couple more questions?
 
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