Charles Posted Wed 28th of November, 2012 16:38:01 PM
A child is diagnosed with sensory processing disorder (315.5) and doctor would like her treated with occupational therapy. Child has BCBS labor fund insurance and insurance will not approve OT treatment for child stating it is too vague of a diagnosis. What primary DX can be used here?
SuperCoder Answered Thu 29th of November, 2012 06:46:32 AM
Physical and occupational therapy provided for developmental delay diagnoses are noncovered. Payment is the responsibility of the Member.
Non-specific diagnosis codes should not be used in billing for physical and occupational
therapy services. If you receive a denial, a more specific diagnosis code placed in the primary diagnosis
field is required in order to be considered for reimbursement for these services.
The following are some possible codes that we may provide to you to request reimbursement from your insurance company. These are not all inclusive, just a sampling.
ICD-9 Codes/Treatment Diagnoses
342.0-344.9 Hemiplegia & Hemiparesis
781.2 Gait Abnormality, Neurologic
781.3 Lack of Coordination, Excludes Gait
315.4 Developmental Dyspraxia
780.9 Decreased Functional Activity
344.2 Diplegia of Upper Limbs
736.72 Foot Drop
784.60 Auditory Processing Disorder.
784.69 Verbal Apraxia
315.39 Speech Delay
ICD-9 Codes/Medical Diagnoses
952.00-952.8 Spinal Cord Injury w/o evidence of spinal bone injury
348.1 Anoxic Brain Damage
436 CVA, Acute
437.3 Aneurysm, Nonruptured
332.0-333.0 Parkinsons & Other Basal Ganglia Diseases
340 Multiple Sclerosis
438 CVA, Late Effects
315.5 Developmental Disorder, Mixed
434.1 Embolism, Cerebral
854 Traumatic Brain Injury
314.00` Attention Deficit Disorder
V49.76 Above Knee Amputation
V49.75 Below Knee Amputation