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Psych Dx in PCP's encounter

  1. #1
    Question Psych Dx in PCP's encounter
    Medical Coding Books
    Hi Everyone,
    I have an interesting question. Patient comes to PCP for everything, right? So PCP realizes that the patient needs to be seen by psychiatrist for whatever reason and refers. He adds a psychiatric Dx to the superbill, which seems legit to me. Question: why Managed Care denies the whole claim for Behavioral Health Dx? ANd how to appeal that? Thank you!

  2. #2
    Columbia, MO
    If the provider is referring the patient to psych, then it is not yet established that the patient has a clinical psych dx. That will be done in the psych setting. Look in the evaluation, examination part of the note does it describe symptoms that warrant a psych eval? If so then it is not correct to append a psych dx code. Without the note I am not able to advise as yo what the codes should be or if the ones you used are correct. I am just giving a different perspective to look at the note. FYI... 311 is not a code for a dx of depression, that is a code for a depressive disorder.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Thumbs up Thank you
    Thank you Debra,
    That makes sense... Just need ot explain that to Docs. They like to apply Psych codes.
    Hold on, what if the Dx was already established by the psychiatrist and PCP knows about it, since she communicates with other providers as well in the same setting? (I have cases like that too). Would she use that Dx? Or, still, none of her business? Thanks a lot again!

  4. #4
    Columbia, MO
    If the patient has an established psych dx, and your provider addresses it then you will need to code and the payer may deny the service.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    That's what I thought! We'll deal with that!
    Thank you again, Debra!

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