Wiki Psychology Services

[knperry]

Hello All!
If Medicare pays a claim for Psychology services but the secondary who is BCBS denies the claim due to the dx code G31.84 not considered a mental health code, and this is the only. Is there anything I can do to get this paid by BCBS?

 

[Skymom]

First, check to make sure G31.84 is, in fact, the best dx for the patient at the time of this visit. If it is, I would consult BCBS's provider manual to see if they have a policy excluding coverage for MH CPT codes with anything other than an F-code as primary. If they don't, I would appeal on those grounds. I'd also check your MAC guidelines to make sure a recoup isn't in your future, if -- in 2 years -- Medicare decides it mistakenly paid the claim for the same reason.