Rochelle Garcia 7 years ago in ICD-10/DSM5 • updated by Richard Sethre, PsyD 6 years ago • 8
I am searching for the correct ICD10 code for a client who was seen for a Diagnostic Assessment but has no diagnosis. In the ICD10 book I found Z71.1. Has anyone used this dx code? Was it covered?
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I have used R69 for the deferred diagnosis, and have been paid on pre-DA appointments. If you are billing for a DA, I don't know if it will be paid.
Not sure if the DA will be paid either with no diagnosis. I did find ICD10 code: Z03.89 "Encounter for observation for other suspected diseases and conditions ruled out". Im gonna give this one a try and cross my fingers!
The Z03.89 should be the correct code. Now that being said, BCBS-MN is having issue with this code and have since the roll out of ICD-10. They are aware that they needto pay using that code they just haven't fixed their system since. It makes for fun claim issues but they claim will get paid.
I recently viewed a webinar presented by Anthony Puente, Ph.D., president-elect of the American Psychological Association and coding expert. He advocated that we can, and should, bill for what we were assessing - in other words, if a patient/client is referred for assessment of possible depression, anxiety, conduct problems, we should bill for depression, anxiety, conduct problems - even we we find that the patient/client does not qualify for the diagnosis. This is, I believe, similar to how PCPs bill - if I go to my PCP thinking that I have a disease, and he finds that I do not have the disease (which is good for me) that does not mean that he cannot bill for seeing me (bad for him). He would bill for the disease being assessed.
Great point! So if a new client comes in and presents with anxiety issues I should bill using the anxiety code "pre-DA"? What if they never come back in and the provider never actually "diagnosed" anxiety?
For those who are interested in billing and coding issues, I posted a summary of Dr. Puente's webinar on my website. He discussed "nuts and bolts" questions like how many codes to use on the HCFA form, what code should be listed first, use of ICD 10 G and R codes, and, in particular, how to fill for a DA which results in no diagnosis or a diagnosis that is not covered by the payer. See www.mhconcierge.com The actual webinar is available only to member of the American Psychological Assoication Practice Organization.
Is this summary still on your website? If so can you provide that information. Thanks!
Sure, glad to help out:
Richard Sethre, Psy.D., L.P.