Improvement

Coding behavioral health when you’re not a behavioral health provider

Behavioral health diagnoses (particularly in the range of 290.00 thru 314.99) are on the hit list of all major insurance carriers. Use these codes and you’ll find that your claims will be denied or reduced with little chance to recoup your loss. The insurance carriers classify any claim submitted with these diagnoses as part of the mental health benefit. In many cases, the mental health benefit administration is outsourced from the insurance carrier to a behavioral health organization. Behavioral health typically requires pre-certification of all services. The net result is that using the psychiatric diagnosis will cause the claim to be processed as out of network or not authorized, and the patient will be responsible for a larger portion of the balance due or the provider may be responsible for the balance due.

From a reimbursement perspective, if you are not a mental health professional you should use a more general diagnosis or symptom code much the same as you may use a more general code for a physical disorder outside of your specialty area. Attention to this detail will help you to avoid grief and lost revenue.