Coding questions from a CPB

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8
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Hello! I have billed the same way for all of my payers but this one seems to think everything is wrong and I am very lost. I am a CPB, not a CPC. Here is some of the feedback I get on just 2 of the many claims I have billed to them:

1. Facility Type not associated with this CPT code
2. Might need a special claim indicator
3. Diagnosis not allowed with procedure
4. "Not covered when performed in this place of service"
5. Taxonomy not allowed to bill procedure

1. I am billing on HCFA electronically. I thought facility type was a 3 digit code that went on the UB-04 form. I'm unsure what they mean, but the POS I use is 57 - Non-Residential Substance Abuse Treatment Facility and one of the many CPT codes I am attempting to bill is H0001 (Alcohol and/or Drug Assessment). How do these not go together?
2. I don't know what a special claim indicator is or where it goes on the claim form.
3. The diagnosis are F10.20 and F12.10 and the code is T1016 (case management), I'm not sure how any diagnosis doesn't go with a case management code.
4. The code is T1016 and the POS is 57. How is a case management not allowed to be performed at a non-residential substance abuse treatment facility?
5. The taxonomy associated with the rendering provider is 101YA0400X (which is addiction (substance use disorder)) and the procedure codes are H0001 (drug/alcohol assessment) and T1016 (case management)

These are all being billed to ProviderOne as these clients have Washington State Medicaid without a MCO plan since they are AI/AN. I've billed these combinations to other commercial and medicaid payers and have had no issues. Can you help?

Thank you so much!
 
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5
Location
Glenside, PA
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I work for a case management organization - you should review your states guidelines for case management/targeted case management. Each state differs. The case managers have to be enrolled in the program specifically, and can usually onyl bill for services related to specific "TARGET" groups -- for example, HIV, or blind.

I hope that helps--case management provided by a physician, or other clinician in a physician's office would be billable under the CPT for case management, I believe.
 
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Location
Conrad, MT
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I work for a case management organization - you should review your states guidelines for case management/targeted case management. Each state differs. The case managers have to be enrolled in the program specifically, and can usually onyl bill for services related to specific "TARGET" groups -- for example, HIV, or blind.

I hope that helps--case management provided by a physician, or other clinician in a physician's office would be billable under the CPT for case management, I believe.

I have a question about the case management CPT codes for private insurance. BCBS of Montana tells me in my denial code "a NOS or Unlisted procedure was billed when there is a specific procedure code for this service" when I bill the T1016 case management. I know T1016 is for Medicaid but I am the new biller for this organization and I wanted to get a denial for the message so I could go hunting. I found the codes but the scenarios I receive from the organization don't really fit. For example, they call the probation office and report in and then make appropriate notes in the chart and they want to bill that out. The 98966-98968 specifically states to the established patient, parent, or guardian. Am I reading too deeply into that? The other reasons I get is completing paperwork for housing, etc...I would think that is included in the E&M but if I'm wrong, please correct me. I'd really appreciate your input. I have spent hours on the phone w/ BCBS to be told to go to psych.org but I don't find anything different there. I'd like to put this issue to sleep.

Thanks,
Marci Huntsinger, CPC
 
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