I have a Nurse Practitioner at our neuro-specialty practice who is and has been taking on patients that have headaches, migraines, etc. which is fine, but she also sees patients for anxiety and other mental health conditions with either ordering MRIs or labs or giving the patients prescription medication specifically for these mental health diagnoses. Does this depend on the patient's insurance company and our contract with that insurance for whether or not the NP can address them?
For some context, I have gotten denials regarding invalid diagnosis when the provider chooses mental health codes in addition to other head injury codes, like Concussion with (or without) loss of consciousness (injury) and Post Concussion Syndrome (mental health). My revenue cycle manager is requesting that I do not remove diagnoses from the Assessment section of the documentation (regardless of whether or not leaving them would be correct coding since we are currently using eClinicalWorks version e11). So, I've been having to either catch the claim and change that before it goes out to the insurance company the next day after the provider signs/locks the encounter. Or, I wait for the insurance company to deny the claim and change or remove the diagnoses with the codes that way. Mostly, I've been waiting for denials since I have a lot of work projects to work on in addition to my regular daily duties.
For some context, I have gotten denials regarding invalid diagnosis when the provider chooses mental health codes in addition to other head injury codes, like Concussion with (or without) loss of consciousness (injury) and Post Concussion Syndrome (mental health). My revenue cycle manager is requesting that I do not remove diagnoses from the Assessment section of the documentation (regardless of whether or not leaving them would be correct coding since we are currently using eClinicalWorks version e11). So, I've been having to either catch the claim and change that before it goes out to the insurance company the next day after the provider signs/locks the encounter. Or, I wait for the insurance company to deny the claim and change or remove the diagnoses with the codes that way. Mostly, I've been waiting for denials since I have a lot of work projects to work on in addition to my regular daily duties.