Z71.9 counseling, unspecified

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I am having trouble with diagnosis code Z71.9 being accepted as a payable diagnosis code for primary care provider. BCBS has told me this is a specialty based ICD-10 code. Primary Care, Internal Medicine double boarded Physician provided a Telemed service to a family who had questions regarding sending their children to daycare due to fears in relation to COVID19. No exposures, no symptoms, no testing, simply asking physician opinion of the safety or potential risk of sending the children to school. Please advise if there is another more appropriate diagnosis that could be considered billable by a PCP, or where I can find information to appeal this denial as I was not under the impression the diagnosis code was specialty based.

thanks in advance for your time and expertise.
Amanda
 

thomas7331

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Since the reason for the counseling you describe is specified, I would choose Z71.89 instead of Z71.9. Both are valid diagnosis codes, but if BCBS is not covering one of these, then I suspect they likely won't cover the other either. You might consider adding Z20.822 for exposure to COVID - it's possible BCBS requires this on the claim to indicate that the services are pandemic-related.

What you're describing as being a 'specialty based ICD-10 code' is a BCBS reimbursement policy, it's not a coding rule (ICD-10 does not have any guidance that limits code assignments to specific provider types.) It may be that your local BCBS has a coverage policy limiting counseling to only their primary care providers. I don't think the policy makes much sense, though, because there is no such specialty as 'Primary Care' - these providers generally have a specialty of Family Practice or Internal Medicine. If BCBS is limiting this service to primary care providers, then it should be covered in cases where an Internal Medicine provider is acting in that capacity. I'd suggest just appealing the denials and hopefully their response will give you some additional information as to how they expect you to bill for this. You may want to escalate this to your BCBS network representative for assistance to see if they can help. However, if the service is simply not a covered benefit for their patients, then the patients should be held responsible for the charges.
 
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