Clinical Social Work Practice Tools:
Billing

An increasing number of clinical social workers have reported to NASW that paper claims submitted on the CMS-1500 form are being denied because boxes 14 and 15 were not completed.

Effective October 1, 2018, several code changes to the International Classification of Diseases-10-Edition-Clinical Modification (ICD-10-CM), will be implemented by the National Center for Health Statistics, a federal agency who created the files under the authorization of the World Health Organization.

Each year the National Center for Health Statistics, releases new, updated, or deleted codes for the International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM). Clinical social workers should use the new codes to avoid reimbursement denials.

Clinical social workers are one of many health care professionals who will be required to use the ICD-10-CM coding system when identifying mental health disorders.

Psychiatric diagnostic codes used by clinical social workers are found in the International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM) “F” section, F01-F99, on Mental and Behavioral Health Disorders. Third-party payers may individually decide which diagnostic codes they will reimburse clinical social workers for.

When seeking reimbursement from third-party payers, clinical social workers are required to use place of service codes in order to submit a professional claim form such as the CMS-1500. These codes specify where services are rendered and may result in a denied claim when used inappropriately.