Wiki Neuropsychology head injury question

[darmobsi]

Hello,

I bill for a group of neuropsychologists who see patients in the hospital after a traumatic head injury. They often bill F07.81, S09.90XA. Medicare will pay if just F07.81 is coded. The commercials will not and most often deny F07.81 and S09.90XA. What are they doing wrong? Is a concussion a brain injury needing S06.??? Any guidance on this issue is greatly appreciated.

 

[SharonCollachi]

One problem might be that the commercials won't accept an F-code because that's a mental health code and they carve out their mental health to someone else.

Although I think a bigger problem is that perhaps they don't have F07.81-Post-concussion syndrome. That is for after-effects of a traumatic brain injury. If they have just had a brain injury, they're not at the after-effects stage.

In my experience, you need the reason for the evaluation - headache, dizziness, aphasia, etc., and the S-code. Once the patient has healed, or reached a plateau, then they are at the after-effects stage.