Precision matters in behavioral health—and not just when speaking with clients and their families. It also matters greatly for documentation and insurance purposes. One of the most common (and costly) errors treatment centers make is mixing up the terms substance use billing vs. substance abuse billing. At first glance, this can seem like a minor oversight, and one the insurance companies will certainly understand. But in reality, this small difference can have major financial and compliance implications.
As a trusted substance use billing company, Integrity Billing helps treatment providers avoid these pitfalls every day. Let’s take a closer look at what you need to know to protect your revenue, stay compliant, and support better care for your clients.
The Shift in Terminology: How and When It Happened
The behavioral health industry has undergone a major shift in how it defines and diagnoses substance use disorders. For example, the terms “substance abuse” and “addiction” have been replaced by “substance use” or “substance use disorder (SUD).” Additionally, we now use person-first language, such as “person with substance use disorder” in place of “addict” or “drug user.”
The purpose of these changes is to use words that aren’t stigmatizing and focus on the person and not their illness. These small adjustments may seem trivial to some, but they can make a difference between a person reaching out for support or not. This update was even formalized in the DSM-5 in 2013, eliminating the older “abuse” and “dependence” categories and replacing them with a single continuum: Substance Use Disorder, categorized as mild, moderate, or severe.
So why does this matter for billing? Isn’t billing about codes and paperwork?
Payers rely on accurate documentation. They expect all documentation and ICD-10 codes to match modern diagnostic standards. Using outdated “abuse” codes can lead to claim denials, compliance issues, and audit risks.
How Incorrect Language Affects Your Reimbursement
In behavioral health billing, words aren’t just semantics; they’re tied directly to your reimbursement. Here are a few ways using outdated terminology can affect your bottom line:
Incorrect Diagnosis Codes
Outdated “abuse” codes are often flagged or denied. Payers now expect DSM-5 aligned codes, such as F11.20 (opioid use disorder, severe, dependence) rather than the old “opioid abuse” terminology.
Documentation Mismatch
If your clinicians write “substance abuse” but your billing team codes for “substance use disorder”, this can create red flags during an audit due to inconsistencies.
Reduced or Denied Reimbursements
Some insurers treat “abuse” codes as less severe and therefore less medically necessary. This can result in lower payouts or complete rejections.
Compliance Concerns
Insurance carriers expect providers to align their billing practices with DSM-5 and ICD-10 updates. This keeps everything clean and consistent. Using the wrong terminology can signify poor compliance practices, increasing audit risk.
How to Avoid Mistakes in Substance Use Billing
Every detail matters in behavioral health billing, so by aligning your documentation with current standards, you’re protecting your revenue and communicating with respect and professionalism. For a behavioral health billing company, accuracy in both language and process is central to ethical billing and client advocacy.
When you partner with Integrity Billing, we make sure that we keep your team informed on the current payer rules, periodically audit your documentation, and provide ongoing training and coaching on the nuances of DSM-5, payer criteria, and ASAM IV and V. In short, our specialists help ensure every claim meets the latest industry standards so that you can focus on client care.
Partner With Integrity Billing: Your Trusted Behavioral Health Billing Company
Behavioral health providers face unique billing challenges, from evolving regulations to complex payer requirements. That’s where Integrity Billing comes in. As a leading behavioral health billing company, we specialize in coding, compliance, and claims management for treatment centers and mental health providers.
Our team ensures your documentation is accurate, your claims are clean, and your revenue cycle runs smoothly. By trusting Integrity Billing, you can rest assured that your behavioral health facility is both compliant and financially healthy. Let us help you navigate the complexities of behavioral health billing with expertise, transparency, and integrity. Partner with us today by filling out our online form or contacting us at 800-683-5640.