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Psychiatric Reduction

mallory615

Guest
Messages
12
Best answers
0
I have received a phsychiatric reduction from Medicare due to diagnosis 305.1 (tobacco abuse). I sent a redetermination to have the diagnosis codes re-sequenced with 305.1 to be last. They reprocessed the claim, removed the psychiatric reduction, but reduced the allowed amount to the psychiatric allowable! Therefore, no additional payment was made. They are telling me that because the diagnosis is on the claim, (regardless of sequencing) we will be paid at the psychiatric rate! Any advice??
 

Walker22

True Blue
Messages
697
Location
Cumming, GA
Best answers
0
Is the doctor a general practitioner, or a specialist? Were you actually treating the patient for the tobacco abuse, or was that just a coincidental diagnosis. Was this an office visit claim, or some type of procedure? I need to know more info.
 

syllingk

Expert
Messages
424
Location
Boise, Idaho
Best answers
0
I would like to know more about this too. I use this code quite abit because it is a cause of gastritis when people come in for epigastric pain and the doc lists it.
 
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