Behavioral Health DX codes

[TiffanyMc]

Good Morning,

I am correcting some coding for our Clinical Social Workers and I'm having trouble deciding which DX codes to use pertaining to therapy for Sexual Abuse of a child. The LCSW saw the patient on a referral from the Primary Care Pediatrician. The DX code used was 995.53 and the Payor denied it as DX not authorized by the Plan. The Plan carrier pays claims pertaining to behavioral health and only accepts claims pertaining to treatment for behavioral health from LCSW's, Mental Health Providers, and Psychologist. Can you help me decide which code would be appropriate when dealing with the "treatment" or "therapy" of behavioral problems associated with child sexual abuse? I was thinking V61.21 would be appropriate but I am reading my ICD-9 book and it states V codes should not be used as the primary dx. Please help. Thanks.

 

[Ruth Sheets]

ICD 9 Guideline I.C.18.b states V codes are for use in any healthcare setting. V codes may be used as either a first listed or secondary code, depending on the circumstances of the encounter. Certain V codes may only be used as first listed, others only as secondary codes.

I'm not sure where you found the statement that V codes should not be used as the primary Dx. Maybe that was specifically for a subcategory of codes?

 

[Laureen]

Hi Tiffany,

Thanks for your question and stopping by the CCO forum.

This is a common misperception. E codes can't be used as primary but SOME V codes can and should be primary. I think your choice of V61.21 "Counseling for victim of child abuse" is a good choice. 995.53 "Child sexual abuse" would be more for the physician making the actual diagnosis. It sounds like your practicioner is providng counseling for an established diagnosis so your V code is more accurate (and hopefully more acceptable to insurance co.)

Happy Coding!