Insurance compensation for patients with Tourette syndrome (TS) is complicated by the diagnosis being in the ICD-9 series for mental disorders (290-319), which may trigger use of mental health benefit rules rather than those for medical benefits. There is ample and mounting evidence, however, that TS is a neurological disorder. Using the code for static encephalopathy (348.3) or unspecified nervous system disorder (349.9), along with the code for TS (307.23) may result in appropriate compensation. If payment is denied, an appeal letter to the insurance company specifiying that TS is a neurological disorder and attaching the TS Fact Sheet (NIH) may help. Adapted from [Zinner: 2004].
|Author:||Samuel H. Zinner, MD - 9/2007|