Wiki Denied claim for 99214 with 90833

[dwizn]

Hello, Our PMHNP is billing 99214 and 90833 together with DX codes F33.1, F41.1 and the claim is being denied. They seem to be appropriate codes and combo's Please advise?
We are a small group with minimal coding experience. When I enter the info into the code scrubber it says that those DX codes require a 5th digit. I have no idea what this means.
A claims rep told our biller she thinks the CPT codes are inappropriate for the provider. I do know that info is false and feel the issue is the DX codes cannot be primary to one another and there should be a different primary DX- but I'm totally guessing. Thank you!

 

[jkyles]

Hi there,

Could you share the denial message(s) you received? It can be impossible to figure out a denial without that information.

Neither of those codes require a 5th digit so I can't explain your scrubber error. However, understanding additional digits is essential to diagnosis coding so be sure to give the ICD-10-CM guidelines a read.

 

[dwizn]

(providence health plan) X67- Service Not Authorized per Provider Contract-provider responsibility. Provider is a PMHNP- 99214, 90833 are in the CPT guide book for his scope. Thank you

 

[TThivierge]

Hi Dwizn
The denial seems it should have had the treatment pre approved before got mental health services. Thus it will not be covered. But check with your payer to be sure. At times some payers want beh. health service provider to do a treatment plan then submitted first. Do you know if this is the situaiton with this payer? Also the 5 digit in the ICD10 manual list this dx block in ranges of F33.40-F33.42. It seems the major depression has levels of recurrent as partial , unspecific and full .Check out the ICD10 manual.
The CPT codes are ok but the provider has to address a medical issue documentation = a medical dx codes to link with CPT 99214. The other CPT odes CPT 90833 link with the dx F33 and F41 just fine.,
Well that is my two cents on the issue. I hope I helped you
Lady T