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Bulletin ID: No. 36 - A Tip to Avoid the Invalid Provisional Diagnosis Code Denials


Friday, February 11, 2011

Revised February 7, 2011

If a consumer presents for an evaluation and you have not been able to determine the presence of a mental health diagnosis after evaluation, the following diagnosis code may be used to avoid invalid diagnosis code denials for consumer evaluations:

V71.09  Observation of Other Suspected Mental Condition
There might be other provisional diagnosis codes that would be more appropriate for you to use. That is a clinical decision and the contents of this Bulletin are not intended to be a substitute for codes that may be more clinically appropriate. However, do not use code 799.9, “diagnosis deferred.” The Department of Mental Health (DMH) denies claims with this code and will continue to deny them. Claims with this diagnosis code will not be forwarded to ACS for payment. They will be returned to the provider to correct and resubmit to DMH.

If you have additional questions, please contact your agency’s designated Provider Relations Specialist.