90837 Behavioral health

[sgilbert029]

Hello everyone, I am stumped on a few claims we have out for a patient. they have Humana Medicare and there behavioral health is being rejected for NDC/LDC coverage. I am not sure were to go from here as we were told to send in a Corrected claim or the office notes but im not sure if that would work, and if i sent a CC there is nothing I can change to correct it. I just wanted to reach out and see if anyone has this problem with another code or knows how I can look up NDC/LDC coverage.

 

[ckeeney]

You can find the NCD/LCD coverage here: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57480

If the diagnosis is not on the NCD/LCD and it is correct per documentation, then there is no option of submitting a corrected claim.

 

[Awalsh129]

Most insurances do not accept unspecified codes, but they do accept "other" codes. For instance, F31.89 other bipolar disorder instead of F31.9 bipolar disorder, unspecified. They also like uncomplicated codes (F10.10 Alcohol abuse, uncomplicated).