Wiki Targeted Case Management (TCM) HCPCS T1017 question

[allib04]

A little background... We are a FQHC clinic and we participate in Medicaid's TCM program. Usually the patients that we have on this program transition from Maternity Case Management to Targeted Case Management after they have had their baby. We mainly only see Medicaid patients under this program, but now we have a patient who has commercial insurance that is denying the T1017 for not being a covered service. This patient had been on our MCM program before having her baby with no billing issues, and the claims that we are having issues with are for the baby.

My first question is - Can we bill these services to commercial plans?

And my second question is - If yes, is there an alternate CPT to use instead of T1017?

 

[TThivierge]

Hi Allibo4,
Check out CPT 96156 Health behavioral assessment to guide patient after birth of baby since before had mental health issues. Use a dx describes and notes consent and have now has had child. Do not add cpt Eval mgt. codes same day or CPT 99401-99412 codes either by same provider see page 825 in CPT manual. The Dx code block might be used are dx O99 if mom suffer with certain type of behavioral health and then add dx F11-19 which fits in the documentation if appropriate. Check out dx F53 and 090 blocks too . However, keep this in mind.. the postpartum period, also known as the puerperium and the "fourth trimester," refers to the weeks after birth when the physiologic changes related to pregnancy. So the problem is the patient is having problems with the baby? What is mother/patient dealing with dx G47 Insomnia or Postpartum Depression F53 or Mood changes dx F06.31 or dx Z62.8?

You did not give enough information but hope some of this may help you. Have a good TGIF!!

Lady T