Coding Question (CMS-1500)

I live in New York and I'm a Medicaid recipient. I think I may have found some fraudulent activity relating to item 14, date of illness or injury, on the health insurance claim form.

I was receiving psychotherapy services for about a year-and-a-half. For every encounter billed, my former therapist included the date of the encounter in box 14. She also used the 431 qualifier, signifying that the date in box 14 was the onset of the diagnosis.

I'm not a coder or healthcare professional so I don't know if this is innocent or nefarious. My perception is that, if a payor is reviewing the claim form, they would be under the impression that there's a new diagnosis or exacerbation of the billed condition. I spoke with my current provider and started to think that maybe that kind of practice would be used to avoid triggering an audit. Again, I don't really know what I'm talking about so I'd love some feedback on why my therapist would have billed that way and if it's a standard practice.

submitted by /u/malchikgey
[comments]