Psychotherapy before DA

What is the statute? Can you provide it?

HI Amy I can't pull the statute and offhand and don't have time to look through for it but you can refer to the DHS site here:

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_058158

And if you look under "Eligible Recipients" you will see this language:

Exception: A new recipient may receive up to three sessions of a combination of individual or family psychotherapy, or family psychoeducation prior to completing the diagnostic assessment.

We wait to bill all the sessions until the DA is completed (leaving no dx code entered so they don't accidentally bill until after the DA is complete)

We have only ever been able to bill a DA with a Z code for the diagnosis. Anything other than that has been denied.

Laura, I usually do the same.  But in the case we can't complete the DA--can't reappoint them or whatever--I end up having to bill it anyway.  Some carriers will accept R69 Deferred Diagnosis.  I have tried the Z codes with no success.  Medicaid won't take either, they have a list of diagnoses that they will pay.  Anything outside that is a no-go.  My two cents worth!

Sheryl

That is a good point.  We actually have not had that situation happen, so its good to know if one of my providers is not able to complete the assessment.

DC: 0-3 DA's with Interactive Complexity (90785) do not get reimbursed for the Interactive Complexity with a Z-code diagnosis. I don't believe CTSS allows any visits to be billed prior to the DA being completed.

Thanks for the insight, everyone. Yes, my main question is what happens if no diagnosis is found or the DA never gets completed. I am not sure why they would allow three psychotherapy sessions BEFORE a DA if they didn't relax what codes can get billed for psychotherapy. I've e-mailed the state, so hopefully I get an answer in a couple of weeks.

Please keep us all posted, Chris. 

Got an answer - it looks like a working diagnosis should be billed, but if the DA ends up not finding a diagnosis, then that is fine.

"When necessary there is an exception, new recipients may receive up to three sessions of a combination of individual or family psychotherapy or family psychoeducation prior to completing the diagnostic assessment (DA).  These claims should be submitted using an appropriate diagnosis code for that specific recipient established from the initial meeting with the recipient and/or the recipients family in order to justify the need for psychotherapy or psychoeducation sessions prior to a completed DA.  It is not required that the completed diagnostic assessment matches to this original diagnosis.  Here is a link to the mental health diagnostic code ranges list published by the commissioner."

dhs.healthcare-providers@state.mn.us;

Was the e-mail I reached out to.

Thanks for posting the response.  This is helpful :)