Procedure Coding

  • The procedure codes billable to the EI-CBO are identified on the authorization for services. Some of these procedure codes include a modifier that must be included on the claim form in order to receive proper reimbursement.
  • A complete listing of these codes can be found in the "Early Intervention Service Descriptions, Billing Codes and Rates" document at http://www.eicbo.info or http://www.dhs.state.il.us/ei.
  • If insurance exists, the procedure codes billed to the insurance company may differ from those found on the authorizations. Providers should refer to the Physicians' Current Procedural Terminology (CPT-4) book that may be purchased from local medical books stores or from one of the resources included at the end of this section. Additional codes can be found in the HCPCS book.

Diagnosis Coding

  • Diagnosis coding discussed in this section does not refer to assigning a medical diagnosis but rather a billing diagnosis. A billing diagnosis tells us "why" you saw the child.
  • Diagnosis codes submitted on claim forms (and on other medical documentation) are generally used to determine insurance coverage. Insurance payment is dependent upon meeting insurance company requirements.
  • Diagnosis coding is translating the medical terminology used for each service/item given by a provider into a code for billing purposes or other medical purposes after EI eligibility.
  • The diagnosis determined for EI eligibility will not necessarily be the same diagnosis used for billing purposes.
  • Code to the level of specificity as required in the code manual.
  • Knowledge of billing and coding requirements are professional developments issues in which each provider must invest time and resources to ensure they can comply with insurance company guidelines.
  • Specific questions regarding insurance denials relating to diagnosis coding should be addressed with the insurance company.
  • Accurate diagnosis and procedure coding directly impacts correct and maximum benefit payment.
  • Proper coding involves using the ICD-9-CM volumes to identify the appropriate codes for items or services provided (as recorded in the patient record), and using those codes correctly on the medical claim forms.
  • Use the ICD-9-CM codes that describe the diagnosis, symptom, complaint, condition, or problem.
  • Use the ICD-9-CM code that is chiefly responsible for the item or service provided.
  • Assign codes to the highest level of specialty. Use the fourth and fifth digits when indicated as necessary in your ICD-9-CM volumes.
  • Code a chronic condition as often as applicable to the patient's treatment.
  • Code all documented conditions which coexist at the time of the visit that require or affect care or treatment. (Do not code conditions which no longer exist.)

The following services do not require an ICD-9 diagnosis code:

  • Evaluation/Assessments
  • Family Training and Support which includes Interpretation, Parent Liaison and Deaf Mentor Services
  • IFSP Development
  • Transportation