Wiki What are behavior and impulse control codes?

[jennbrooks]

I don't know if this should be here or in the diagnostic forum, I am curious if anyone has a list of what diagnoses fall under "behavior and impulse control"?

We have a client whose insurance has listed "no benefit" under "Personality Disorders" and "Behavior and impulse control". I called the insurance to clarify what that meant but all they would say is if we felt like the diagnosis fell under a category that it wasn't covered.

Thanks in advance!

 

[TThivierge]

Hi Jennibrooks
Umm impulse and anger control may be diagnostic codes such as: dx block of F63 (stealing, hair plucking,gambling ,fire starting). Also see dx F60-F69, F68 dx F95 Tic DO and maybe Dx F07. I read this data in the ICD10 manual. Also there are some good Z dx codes (Z60 to Z63) to add on the end of the claim if appropriate with documentation.
I hope this data can help you.
Lady T

 

[thomas7331]

I don't know if this should be here or in the diagnostic forum, I am curious if anyone has a list of what diagnoses fall under "behavior and impulse control"?

We have a client whose insurance has listed "no benefit" under "Personality Disorders" and "Behavior and impulse control". I called the insurance to clarify what that meant but all they would say is if we felt like the diagnosis fell under a category that it wasn't covered.

Thanks in advance!

The insurance company must have a list, otherwise how would they make their payment determination? Any answer you get on this forum is likely to be just speculation as we can't tell you what an insurance plan's official criteria are going to be.

They told you they would not cover it "if they felt like it"??? Honestly? If who felt like it? I think they were not giving you accurate or complete information and it sounds to me like they were just trying to get you off the phone. I would not have accepted that answer from a rep and I would have escalated the call to someone who had more knowledge of the benefits. Or contact your network rep if you can't get a good answer over the phone.

 

[jennbrooks]

The insurance company must have a list, otherwise how would they make their payment determination? Any answer you get on this forum is likely to be just speculation as we can't tell you what an insurance plan's official criteria are going to be.

They told you they would not cover it "if they felt like it"??? Honestly? If who felt like it? I think they were not giving you accurate or complete information and it sounds to me like they were just trying to get you off the phone. I would not have accepted that answer from a rep and I would have escalated the call to someone who had more knowledge of the benefits. Or contact your network rep if you can't get a good answer over the phone.

Thank you. I felt the same way. I did push the rep more and she said that reps were not given a list of what is approved or not. I plan on calling today today and if it is a similar response then I will escalate.

This is UMR but handled by Quantum.

 

[amyjph]

What are the procedures and diagnoses being billed? I think there is more here than just the diagnosis. Have you checked the patient's plan coverage and/or did the treatment require pre-authorization? In a quick search online I found a number of plan guides that indicate exclusion from coverage: MENTAL HEALTH EXCLUSIONS: "Conditions listed in the most recent American Psychiatric Association Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases - Clinical Modification (ICD-CM) manual (most recent revision) in the following categories:  Personality disorders; or  Behavior and impulse control disorders; or  “V” codes (including marriage counseling)."

Did the provider/provider office verify coverage and/or benefits before providing care?

It sounds to me like what they were telling you is the member has no coverage for that type of service. It would be like if my insurance specifically stated it doesn't cover chiropractic care. Yet, I go to one and try to submit a claim, it doesn't matter what diagnosis I put on there, they aren't going to pay it.