Quick Explanation
Denial code MH31 occurs when a behavioral health claim is rejected because the medical documentation fails to prove that structured Dialectical Behavior Therapy (DBT) skills were actively taught during the session. To satisfy billing requirements, providers must clearly document the specific DBT modules and skills addressed, rather than general talk therapy. Without this explicit clinical evidence, insurers will deny the claim under the assumption that the specialized criteria for DBT were not met.
Common Causes for MH31
Denials with code MH31 typically happen for the following specific reasons:
- Clinical documentation describes general supportive psychotherapy instead of structured DBT skill-building techniques.
- The progress note fails to specify which of the four core DBT modules (Mindfulness, Distress Tolerance, Emotion Regulation, or Interpersonal Effectiveness) was taught.
- There is no documented evidence of the patient's active engagement, understanding, or homework assignment related to the DBT skill.
- The provider billed a specialized DBT-related code (such as H2019 or localized behavioral health codes) but used a generic templates that lacks intervention specificity.
How to Prevent MH31 Denials
To avoid receiving this denial in the future, implement these specific checks:
- Utilize EHR templates customized for DBT that prompt clinicians to explicitly record the module, specific skill taught, and the patient’s response.
- Train clinical staff on the documentation distinction between standard psychotherapy and structured psychoeducational DBT skills training.
- Regularly audit behavioral health charts to ensure notes include the review of previous homework, active skill instruction, and future practice plans.
- Verify that the billing codes utilized align perfectly with the structured clinical activities described in the session notes.
Appeal Letter Template for MH31
If you believe this claim was denied incorrectly, you can use the following template to submit an appeal.
[Your Practice Header]
[Date]
[Payer Name]
[Appeals Department Address]
RE: Appeal for Claim [Claim Number]
Patient: [Patient Name]
ID: [Patient ID]
Date of Service: [Date]
Denial Code: MH31 - Dialectical behavior therapy skills not taught
Dear Appeals Department,
I am writing to appeal the denial of the above-referenced claim, which was denied with code MH31: "Dialectical behavior therapy skills not taught".
We are appealing the denial of the claim for Dialectical Behavior Therapy (DBT) services, code MH31, for the date of service [Insert Date]. A comprehensive review of the attached clinical documentation demonstrates that the session fully adhered to the AMA and CMS standards for structured DBT skills training. Specifically, the provider actively instructed the patient on the [Insert Specific Skill, e.g., Distress Tolerance/Mindfulness] module, detailing the therapeutic exercises performed and the patient's response. As the documentation clearly outlines the teaching of distinct, evidence-based DBT skills rather than general psychotherapy, we respectfully request that this denial be overturned and the claim be processed for immediate payment.
Attached please find:
1. A copy of the original claim.
2. The relevant medical records supporting the service.
3. [Any other supporting documents].
We respectfully request that you reprocess this claim for payment.
Sincerely,
[Your Name]
[Title]
[Practice Name]
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