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 Post subject: Codes for Insurance Coverage/Re-imbursement of MMT
PostPosted: Fri Oct 16, 2015 2:04 pm 
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Joined: Sun May 04, 2014 9:54 pm
Posts: 196
Location: North Georgia
We have new coding for insurance and diagnoses, procedures, etc. that rolled out on 10/1 of this year (2015)... There are now much more specific codes, and I think that will help many patients who have insurance get re-imbursed that haven't been able to before. For example, there is now a ICD-10 procedure code specific to "Pharmacotherapy for Substance Abuse Treatment, Methadone Maintenance" where as before, in ICD-9, there was no procedure code specific to MMT as a bundled service. The only procedure code we had before was not an ICD code, so Medicare and many other insurances didn't recognize it...it was hit or miss. There is ALSO a more specific diagnosis code now too... the ICD-10 diagnosis code is now specific not only to opioid use disorder but also signifies "uncomplicated" (on maintenance therapy). So hopefully the new coding will help. Even if folks can't get coverage back to Jan. 1st of this year, hopefully starting 10/1/15 it will be a different (much better) story.

I'll list all the codes here... ICD-9 codes are the "old codes" that are used through 9/30/2015 (so if you're submitting for re-imbursement or coverage back before 10/1/15 you'll still need to use these "old codes)." The ICD-10 codes are the "new codes" that need to be used starting 10/1/15 going forward. If you are submitting for re-imbursement for the entire year up to this point, you will need to submit at least two SEPARATE claims. One for 1/1/15-9/30/15 using the "old codes" below and then another for 10/1/15-present using the "new codes" below.

ICD-9 (through 9/30/15) Codes ("old codes"):
Diagnosis Code: 304.00 Opioid Type Dependence, unspecified
(Source: http://www.icd9data.com/2014/Volume1/290-319/300-316/304/default.htm#304.0)
Procedure Code: H0020 Alcohol And/Or Drug Services; Methadone Administration And/Or Service (Provision Of The Drug By A Licensed Program)
**NOTE: This procedure code is NOT an ICD-9 code (there is no ICD-9 code specific to MMT), so it is not universally recognized. It is NOT recognized by Medicare, though it is by different private insurance companies. (Source: https://www.hipaaspace.com/Medical_Billing/Coding/Healthcare.Common.Procedure.Coding.System/H0020)

ICD-10 (from 10/1/2015 going forward) Codes ("new codes"):
Diagnosis Code: F11.20 Opioid Dependence, uncomplicated, on maintenance treatment
(Source: http://www.icd10data.com/ICD10CM/Codes/F01-F99/F10-F19/F11-/#F11.22)
Procedure Code: HZ91ZZZ Pharmacotherapy for Substance Abuse Treatment, Methadone Maintenance
**NOTE: This is the first ICD procedure code, with the new codes through ICD-10, specific to MMT. Even if you don't have luck going back to Jan. 1st, 2015 using the older codes above, many patients should start seeing coverage with these new ICD-10 codes now that they will be universally recognized. (Source: http://www.icd10data.com/ICD10PCS/Codes/H/Z/9/1/HZ91ZZZ)

I hope this helps some folks!


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 Post subject: Re: Codes for Insurance Coverage/Re-imbursement of MMT
PostPosted: Fri Oct 16, 2015 2:41 pm 
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Joined: Wed Jul 15, 2015 10:09 am
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Do these new codes apply to suboxone/buprenorphine treatment as well? I've had 4 different suboxone doctors over two years and only one of them has ever been able to produce documentation (or even knew what I was talking about) to self-file with my insurance company. I had a similar problem at the methadone clinic I went to for three years, but they were compassionate and caring enough to do the work required to determine what I needed.

This seems like something all providers should know how to do, but in my experience very few understand these procedures and almost none directly accept insurance.


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 Post subject: Re: Codes for Insurance Coverage/Re-imbursement of MMT
PostPosted: Sat Oct 17, 2015 1:12 am 
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Joined: Sun May 04, 2014 9:54 pm
Posts: 196
Location: North Georgia
These codes are specific to methadone maintenance treatment in an opioid treatment program (as the procedure code above details). Buprenorphine from a physician through prescription is a totally different ballgame, and it wouldn't need a specialized bundled service code that includes the physician visit, counseling, medication and everything all in one procedure code. It would be a doctor's office visit and then filling a prescription at a pharmacy. But again, to answer your question, no these codes are not for buprenorphine patients in a physician's office (though a buprenorphine patient who attends an OTP and gets their medication dispensed through a clinic could possibly use these codes).

I encourage you to research the new ICD-10 codes and see if you can find anything specific to buprenorphine.

_________________
Zac Talbott, CMA
Email | zac@tnmethadone.org

Chief Operating Officer | Counseling Solutions Treatment Centers
Comprehensive Opioid Treatment Programs
Program Director | Counseling Solutions Treatment Centers - Chatsworth


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 Post subject: Re: Codes for Insurance Coverage/Re-imbursement of MMT
PostPosted: Mon Oct 19, 2015 6:13 pm 
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Joined: Fri Jul 17, 2015 6:41 pm
Posts: 10
Thanks for the new coding. My clinic (CRC / Acadia) just gave me my first bill in 9 months due to their INSANELY horrible corportate billing center's practices. I got a bill for $900 last month and am looking at another bill for $900+ coming up tomorrow. It's totally insane.


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