ICD-9 Code doesn't exist for PANDAS

[mdmom]

Maybe I'm missing something here, but I have read many posts where people have said that their doctors ordered IVIG for PANDAS and insurance agreed to pay. I now United HC does include PANDAS in their policy, but it seems that most plans do not.

 

There is not even an ICD-9 code for PANDAS - how can a doctor order something for a dx that doesn't exist?

[Kiera]

Maybe I'm missing something here, but I have read many posts where people have said that their doctors ordered IVIG for PANDAS and insurance agreed to pay. I now United HC does include PANDAS in their policy, but it seems that most plans do not.

 

There is not even an ICD-9 code for PANDAS - how can a doctor order something for a dx that doesn't exist?

I think most Drs still bill under post infectious encephalitis etc but when ins asks for letter of medically necessity maybe PANDAS is mentioned then?? Or if ins requires more info like Dr's notes etc it may say pandas all over the notes. Or maybe the ins co. presumes it's Pandas when it sees post strep triggered encephalitis. I know cigna has an "exclusion" clause for pandas in their policy, even though pandas does not technically really "exist" in mainstream medicine.

[beeskneesmommy]

Filed under immune deficiency or autoimmune disorder unspec. Whatever you do, don't use the term PANDAS when trying to get approval from insurance.

[bulldog24]

I heard that a code is coming in the ICD 10