Coding for Insurance Claim Forms

[its2much]

Is anyone familiar with coding for an insurance claim? Who assigns the codes in the office? Claim was recently rejected as doctor is out-of-network for "mental health". Does a diagnosis of depression along with several other diagnoses require a doctor to be a psychiatrist? I didn't see my doctor to be treated for depression. Also aren't there different procedure codes for an office visit and psychotherapy? Been seeing this doctor for years and never had insurance claim problems before..

[Temagami]

You could ask the doc´s office to resubmit the claim with a different coding number.

[its2much]

I spoke with Billing Department at doctor's office. They will not change it. In fact, at first, they wouldn't give me any information regarding what was indicated on the claim. They finally gave me the diagnosis codes that were submitted with the claim.
Extremely frustrating!!

[SNOOPY]

You Health insurance told you why the claim was rejected ---

Claim was recently rejected as doctor is out-of-network for "mental health".

This has nothing to do with billing codes.

It's your responsibility to be aware of what is and isn't covered by your health insurance. You should be able to go online and find the information about your coverage and Drs. that are covered. What may have been covered last year may have change this year.

[pennstater]

When I was being treated for depression, the psychiatrist would bill under this code as primary.

My neurologist or PCP would list it as a secondary diagnosis if need be, but their primary was always non-depression related. It was always billed under the primary code.

If your OV was similar to other prior visits approved, you could ask for a prior approved visit to see if billed under same codes.

If they changed the billing code for OV, you could ask why and let them know the impact. If they didn't change the billing code from prior visits, then it appears your insurance plan changed and your doc is now out of network. If this didn't change, then they may have erroneously approved before!

[its2much]

My Doctor is an in-network doctor

Insurance company paid several claims last year (2016) yet this one claim from last year (2016) they did not. Insurance company says doctor is out of network due to one of the nine diagnosis code (depression) that was listed on the claim. The procedure code was NOT a "mental health" procedure code.

[SNOOPY]

It sounds like you need to discuss this with your insurance carrier to straighten out the confusion.