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    Wiki TBI (S06.-) and Dementia (F02)

    I am in a dilemma. We are a behavioral health facility and often the medical condition documented as cause of the dementia is a (old) TBI. I interpreted the dementia as sequela/late effect, however although not specifically indicated as not a principal diagnosis, we have a payer who is...
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    Wiki Coding help oral/dental

    I code for a psychiatric inpatient unit and had the following medical issue during a patient's stay. Mucous membranes moist, poor dentition, first upper molar on R with significant decay and pus visible. Edema on Right cheek extending to under R eye, no erythema, no ecchymoses. No x-rays done...
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    Wiki Help with Diagnosis Coding

    I need some input on how to code the following: Patient was seen by a psychiatrist for audio and tactile hallucinations. Reported principal diagnosis by the provider is F06.0 - Psychotic disorder with hallucinations due to known physiologic condition. For the underlying conditions the provider...
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    Wiki Crisis Services

    We are a community mental health center and there is a project to operate walk-in crisis intervention centers. Are there any thoughts about H2011 vs. 90839? We know that Medicare does not pay for H2011 (generally, only Medicaid will). We are also aware of different provider level restrictions on...
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    Wiki Inpatient/Observation Same Date Admission/Discharge

    With the revisions in 2023 the codes for same day admission and discharge show a revised description: ▶The following codes are used to report hospital inpatient or observation care services provided to patients admitted and discharged on the same date of service. For patients admitted to...
    • ckeeney
    • Thread
    • Replies: 0
    • Forum: E/M
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    Wiki Home and Nursing Facility Services

    I have been reviewing the 2023 guidelines for the recently updated E&M services and had some questions. We are a specialist group that has been providing services to rest home, assisted living, group home, etc facilities. Some of these services may now fall into the nursing facility category. I...
    • ckeeney
    • Thread
    • Replies: 1
    • Forum: E/M
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    Wiki 2023 E/M Guidance

    I have been searching in the new CPT book and on the AMA as well as this site and I can't seem to find an answer: under the new guidelines for IP/Observation and Home services will the overall MDM level be determined by meeting and/or exceeding all 3 categories or 2 out of 3? Anybody have a...
    • ckeeney
    • Thread
    • Replies: 1
    • Forum: E/M
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    Wiki Condition Codes

    We recently discharged a patient from our psychiatric inpatient facility to a SNF. We used discharge status 03. The Medicare Advantage plan rejected the claim for a condition code. Can anyone suggest what code(s) we need to use? Further research into this stay revealed patient was inpatient at...
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    Wiki Discharge to SNF

    We recently discharged a patient from our psychiatric inpatient facility to a SNF. We used discharge status 03. The Medicare Advantage plan rejected the claim for a condition code. Can anyone suggest what code we need to use?
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    Wiki Behavioral Health Inpatient Billing

    I am relatively new to the billing side of behavioral health. The scenario is as follows: Patient had an extended inpatient stay with sufficient psych days. Medicare and Medicaid payers. Claim denied for no use of lifetime reserve days. Patient was not notified of the need for lifetime reserve...
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    Wiki Claim Denials

    This is specific to Indiana Anthem Medicaid: We have one Care Connect client in behavioral health whose claims are being denied since August of 2015 for Ordering/Referring/Prescribing or Attending Provider's NPI is missing or invalid. We have billed group therapy done by an LCSW under the...
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    Wiki Limit Class

    This is specific to Indiana Anthem Medicaid: We have one Care Connect client in behavioral health whose claims are being denied since August of 2015 for Ordering/Referring/Prescribing or Attending Provider's NPI is missing or invalid. We have billed group therapy done by an LCSW under the...
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    Wiki Dx help

    I am trying to code exposure/effect of maternal use of cocaine for a patient older than a newborn. I have looked at exposure, effect, history and am not coming up with anything. There are no documented congenital malformations. Has anyone found a code for this? Patient's first-listed diagnosis...
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    Wiki Gait and Psychomotor Pacing

    Can a mention of psychomotor pacing be used to count Gait as having been evaluated under the 1997 guidelines for psychiatric E/M coding? What I have seen is that psychomotor pacing is an indication of psychiatric disorders and is part of the psychiatric and/or neurologic evaluation. Would...
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    Wiki Hx of tonsillectomy/adenoidectomy

    Our pediatricians would like to code for this. They had V45.9 that has been deleted. My reading shows this is a postprocedural code. That category has V45.89 Other postprocedural status. I also found V15.29 Personal history of surgery to other organs. Any thoughts on the appropriate code?
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