Comprehensive Assessments that result in no diagnosis

Jenna 3 years ago in ICD-10/DSM5 updated by Shauna Dall 3 years ago 6


 We are struggling to get claims paid when a comprehensive assessment result in a no diagnosis - diagnosis. 

Assessment are to figure out if in fact someone has a SUD. Sometimes they do not. 

Has anyone used a specific no diagnosis code they have been able to get paid?



We were told by one payer to use code Z03.89; this code does work for several of our payers, but sometimes in the past BCBSMN/Blue Plus wouldn't pay this code.  

We have tried Z03.89 but like stated before, it's not accepted by all payers, so we've also used R69, which also sometimes gets denied.  I haven't tried the Z71.1, so will add that to our list to try as well. 

Currently Payer United Healthcare (Optum) is denying Comprehensive Assessments where we are using Service Code H0001 with Revenue Code 0945.  This client has no diagnosis so we use Z03.89.    When I called Optum I was told to use an F Code and it would be paid.    Can someone suggest coding they are using and receiving payment on claims?

Thank you, Mary

Mary, you could try F99.  We also use Z71.89 but if the F code is required that is what I would try.  Go to icd10data.com and it will tell you which codes are billable (if you don't already know that trick).  Have a wonderful day!