The Record - for physicians and other health care providers to share with their office staffs
Forward to a friend  |  Subscribe  |  The Record Archive  |  Contacts  |  bcbsm.com  |  Print this article
January 2014

Reminder: Psychiatric, subacute detox facilities should not submit claims for acute medical detox

Recently, Blue Cross Blue Shield of Michigan has received incorrect claims from residential substance abuse rehab facilities.

The claims have inappropriately included the diagnostic codes for acute alcohol withdrawal (ICD-9 codes 291.XX or 292.XX series) for patients who are actually receiving subacute detoxification and rehabilitative services.

Detoxification is the process of withdrawing a patient from the dependence of one or more addictive substances. There are two categories of services for detox:

  • Acute detoxification services are provided in an inpatient, acute-care hospital setting. These services are for patients who require treatment for physiological withdrawal symptoms that are severe or life-threatening.
  • Subacute detoxification services are provided during residential or outpatient treatment. These services are for patients who suffer physiological withdrawal symptoms that are not life-threatening. Instead, the patients require a coordinated rehabilitation treatment program to assist them in attaining an unimpaired or improved level of physiological, psychological and social functioning.

Residential facilities are not licensed to provide acute medical detoxification. Therefore, those facilities should report subacute detox and rehab treatment services with the diagnosis code range of 303.XX, 304.XX and 305 series.

BCBSM may attempt to recover 100 percent of the reimbursements paid to providers when we identify claims that have been billed incorrectly. 

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2013 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.