Optum should have a list of payable diagnoses for all mental health care. When I was in mental health, I had several binders (in ICD9 days) of parity dx, non parity dx, etc., for different insurance companies. While I do believe that all of the F codes should be billable in mental health, the F59 series deal with behavioral syndromes associated with physical factors. In the old days, this was called a parity diagnosis. Alot of insurance companies would have you bill parity diagnoses to the medical coverage, and mental health diagnoses to the mental health coverage. So that might be another avenue to explore, although I don't think that is the problem in this case.
So here's my thought... the patient is not being treated for insomnia with psychotherapy. They are being treated for the EFFECTS of insomnia (just as if the patient were going thru a divorce, they are not being treated for the divorce, they are being treated for the effects of the divorce). That could be an adjustment disorder, depression, anxiety, etc. I would present that information to the provider and see if there is another, valid, diagnosis for the patient.
