Case Study: Dual Diagnosis
A CASE STUDY ON DUAL DIAGNOSIS VS. SUD ONLY. DUAL DIAGNOSIS TREATMENT CAN IMPROVE PATIENT OUTCOMES AND EXTEND LENGTH OF STAY.
To start, every insurance company has their own medical necessity guidelines, but we want to provide an overview of our general experience with dual diagnosis billing. We are often asked the question, when should a client at PHP or IOP switch from their Substance Abuse primary authorization to a Mental Health primary authorization. Our answer is always “it depends on the focus of the individual sessions”. Typically, we see SUD authorizations run first, with mental health authorizations coming after initial cravings & withdrawal symptoms are stabilized and patients can start opening to underlying conditions or trauma.
…for dual diagnosis patients, we estimate about a 25% increase in length of stay for residential and a 50% increase in length of stay for PHP and IOP.
Additionally, for dual diagnosis patients, we estimate about a 25% increase in length of stay for residential and a 50% increase in length of stay for PHP and IOP. This absolutely varies patient to patient based on presenting symptomology and treatment progression. What we see, however, is that dual diagnosis patients typically take more time to stabilize their medications, and at IOP often require additional days to address underlying trauma and/or PTSD symptoms.
We’ve had success with increasing length of stay for patients in a dual diagnosis program vs. a traditional SUD program, however the degree of improvement is tied to the quality of the documentation, utilization of assessments, and the overall treatment plan progression. We have seen insurance payers more likely to cover an additional 14 days of PHP and 14+ days of IOP if it ties directly to mood/symptom stabilization, ties into a comprehensive discharge plan, and is supported by clinical assessments such as the GAD-7 or PHQ-9.
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We work with our clients to help them navigate these insurance requirements and expectations in order to best serve their patients and assist them with securing the days their patients need to find recovery. Contact us today to learn more about our specific improvements, expectations, and strategies for implementation.