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

To avoid invalid diagnosis code denials, providers must use a valid diagnosis code.

If you have not been able to determine a specific diagnosis prior to billing, but you have some indication that the consumer has a mental disorder, you can use a valid provisional diagnosis code. For example, you may use:

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 denies claims with this code and will continue to deny them. The Department will not forward claims with this diagnosis code to ACS for payment. They will be returned to you to correct and resubmit to the Department.