Help needed: recurrent depression HCC 58 is being denied by payers
Our facility is part of an ACO, so capturing all relevant HCCs is very important. We developed a CDI query for this HCC following a presentation at the Outpatient CDI Conference last year. Our CDIs query the providers if a patient has a diagnosis of depression, is on home meds for depression and we continue the medication during the hospital stay, we ask if the depression is a single episode, a recurrent brief episode or a recurrent ongoing depression. We are not a psych facility, therefore our providers are not comfortable diagnosing mild, moderate, severe or saying the depression is in remission. Thus we are left coding recurrent depression as either F 33.8 (recurrent brief depressive episodes) or F 33.9 (ongoing monopolar episodes) based on provider response. However, we are now experiencing payer denials for coding and billing F33.8 or F 33.9. The payers are pushing for coding criteria and want to know how we define these diagnoses. We have done some literature research regarding these codes and it is minimal, at best. I am reaching out to ACDIS to ask for help. Does ACDIS have some definitive criteria on when to use these codes, F 33.8 /F 33.9, and some advice on how we might defend these coding payer denials?