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Behavioral and Medical Advantages of Neutering Your Dog

When most owners think of neutering their male dogs, they usually consider it in the context of controlling their mutts’ natural carousing and mating habits. While that is a compelling reason, there are also behavioral and medical advantages to doing so. The presence of testosterone creates a number of psychological and health-related issues. This is why experts discourage owners from having vasectomies performed on their canines; it removes their ability to reproduce, but does not eliminate the production of testosterone.

Below, we’ll describe the behavioral and medical benefits of neutering your pooch. You’ll learn how the procedure can lead to changes in his aggression and roaming tendencies. We’ll also explain how it reduces the likelihood of your dog developing tumors, hernias, and other problems.

Behavioral Benefits

Castration of male canines stops the production of testosterone and other hormones. These hormones are largely responsible for a dog’s natural aggression toward other animals as well as toward people. Aggression in this context is not limited to physically threatening others; it can also manifest as mounting as early as at seven or eight weeks of age. Neutering reduces this behavior, though age plays a role in the level of reduction.

Roaming is another natural tendency that castration curbs. Your pooch is instinctively driven to roam in search of female canines that in heat. When they are in this condition, females release pheromones into the air. These pheromones can attract male “suitors,” often from miles away. When you neuter your pooch, this instinct vanishes.

Medical Benefits

The health-related advantages for a neutered canine are even greater than the behavioral benefits. First, tumors can manifest in a dog’s testicles by the time he reaches age five or six. Castration removes this vulnerability to cancer at an early age. Second, perianal hernias are common in adult canines that have not been neutered. Experts believe this is due to hormones relaxing the muscles that are located near the anus. Third, the growth of perianal tumors can be fueled by testosterone. Neutering removes the hormones that lead to – or exacerbate – perianal hernias and tumors.

The most significant health-related issue resolved by neutering is the development of prostate disease. It is estimated that over 75% of dogs that have not been neutered cope with problems within their prostate (i.e. cysts, infections, etc.). All are due to the presence of testosterone.

The best time to have your pooch neutered is right after he turns six weeks old. The more time that passes, the greater likelihood that he’ll develop behavioral and health-related issues. Despite what many owners think, early neutering will not have an adverse effect on your canine’s growth. On the contrary, having him neutered may very well prolong his life.

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United Behavioral Heath withholding reimbursement for IRS reasons????

I was going to post this in the Behavioral Health section, but this is more about general payment.

Our facility (which has only been open since August 2016) has had a portion of all UBH payments withheld on a special memo line with a remittance code the states: "The IRS requires us to withhold a percentage of benefits paid to the above taxpayer name and ID number. This amount has been sent to the IRS as prepaid federal taxes. The patient is not responsible for this payment."

Our facility is out of network and these plans are mostly self funded, but I have never heard of taxes being paid on insurance benefits, especially when they are assigned to the provider. The claims reps from UHC cant even see the withholding since it appears to be after adjudication so it only shows up on the remittance. One UHC rep suggested that we might owe back taxes but as I mentioned before our facility had only been open 17 months and there is no way any sort of lien would happen on the 2016 taxes and we haven’t even begun to file our 2017 taxes.

If anyone can shed any light that would be great. I do have 3 separate investigations going on at UBH, but they wouldn’t elevate this to the management level as of yet. I need to get resolution to this soon since its taking 28% of our revenue from UHC (which is are largest payer)

In 10 years of doing this I have never seen anything like this. Please help.

Medical Billing and Coding Forum

Behavioral Health Code H2019

Needing some guidance regarding reimbursement of this code. We use it to reflect TRAILS Social Skills which is a kind of hands on group. Typically the sessions are 2 hours long, thus we bill 8 units (since its a 15 minute code).
My issue is: The carriers that do pay only permit 4 units stating "The member’s plan provides coverage for charges that are reasonable and appropriate. This procedure exceeds the maximum number of services
allowed under our guidelines for a single date of service." When I inquire to show me the policy on max units for this code in their policy – they have nothing specific only that 4 is reasonable & appropriate. Does anyone know where I can find an MUE (Maximum Allowed Average) of sorts for this code? Or have suggestions on appealing it? Thoughts in general are welcome!! :)

Medical Billing and Coding Forum

E & M coding in mental and behavioral health

I have a practitioner who disagrees with me on a coding issue.
I audit all of their charges that are above and 99213. when she documents its as follows
HISTORY
CC: is good
HPI: 3 areas
PMFSH: nothing she skips all
ROS: 5 areas
I SCORE HISTORY AS (EPF) expanded problem focused (because she does not document PMFSH) she states this should be scored as (detailed)?????

can I get someone else’s opinion please.

Thanks

Medical Billing and Coding Forum

Behavioral Health billing questions

Hello, I’m relatively new to this and would appreciate any help.

I’m billing for a LMFT and am confused on several things:

90791: I have billed 90791 as an initial visit code for this provider, but it seems that some insurances require or pay on 99404. However I’m not sure why/when to use 99404.
Is 90791 an initial visit code for non EAP pts only?

99404-I’m unclear if my provider (LMFT) can use E/M codes (99404), if so, when? I’m unclear why 99404 would be used over 90834, etc.
Is 99404 an initial visit code for an EAP pt? If not is there such a thing?

Modifier HJ: I’ve used 90837 with HJ as a modifier for EAP pts, but not in every case and have been paid either way which makes me confused about when to use the modifier. Should it be used every time and for all insurances when billing for an EAP pt?

Thanks for all your help, I really appreciate it.

Medical Billing and Coding

Behavioral Health Notes and Addendums

I am looking for some help with some supporting documentation and or thoughts from other coders that have worked in the behavioral health arena for a while.
Since I am new to the behavioral health arena, it is hard to find rules and guidelines for documentation requirements that reference behavioral health notes. For example, we have a clinician that is struggling with hitting all of the points that Medicare deems needs to be met in the note to support Psychotherapy codes. The question was raised that "well can we just add an addendum to add the information that is needed to support the code?"
I know that there are rules and guidelines for some things like :confused:time coding that indicates that a time spent face to face with a patient must be in the original note, can not be added as an addendum… does anyone have any suggestions of where I might find supporting documentation stating that to support psychotherapy codes the information must be in the original document, not added in an addendum?

Any help is greatly appreciated!
Thanks!
Kristen

Medical Billing and Coding | AAPC Forum