Wiki Case management billing-help!

[Kirstyn20]

I am a long time family practice biller, and have just been handed a mental health clinic.
So much different! I am unsure how to bill for the case management services. I know the
T1016 and T1017 codes are for Medicaid. I have asked the provider to choose the CPT code for
commercial and 99366 is accurate to what is being done. Description states, "Medical Team Conference,
Face-To-Face with Patient and/or Family, 30 Min or More, Participation by Nonphysician." I am having
a hard time getting this code paid. We are listing the NP as the provider, because we can't bill under
a non physician. I think our claims are denying because the rendering provider on the claim is an NP
and NP's are excluded from this benefit. How does everyone else bill for this service?
Thank you!

 

[SharonCollachi]

First, case management is not team conference; team conference is two or more disciplines. What exactly is being done for the case management?

Second, many policies exclude case management from separate reimbursement and consider it part of the regular overhead and/or bundled into the regular service.

 

[harpermmb]

I am new to this to I have a certified case manager that does weekly phone and in person visits with patient to see how they are doing. She administers PHQ and GAD, handles all paperwork and transfer them to inpatient if needed.

 

[jsass5]

I too am looking for some guidance on this situation. We have a case manager that sees the patient in the office and helps them with housing paperwork, etc, PHQ's and GAD's also. We have also been using the T1016 & T1017 with no luck. Any guidance on this issue would be greatly appreciated. Thank you!

First, case management is not team conference; team conference is two or more disciplines. What exactly is being done for the case management?

Second, many policies exclude case management from separate reimbursement and consider it part of the regular overhead and/or bundled into the regular service.