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cpt code

victor Posted Thu 13th of February, 2020 14:14:40 PM
I run an In patient rehab unit. I make rounds every day and bill with the 99233 code. We are required by medicare law to do a multiple disciplinary staffing sometime called patient care confrence which includes meeting with all the therapist and then meeting with patient and family. I have a retired MD who will come in and do the confrence. I will still see the patient for medical and bill the 93233 code. Is there a code the other MD can use so he can bill for the visit on the same day I see the patient? Also, if there is such a code, what is the required criteria?
SuperCoder Answered Fri 14th of February, 2020 02:27:43 AM

Hi,

 

Thanks for your question.

 

As per the documentation provided, it appears that the medical team conference codes are appropriate to use for the above scenario.

 

The below article will provide you with the codes and criteria to bill for the medical team conference.

 

A medical team conference is the face-to-face participation by a minimum of three qualified healthcare professionals from different disciplines/specialties who are directly involved in the care of the patient. The presence of the patient or his representatives is optional in such conferences (except in case of 99366).

 

The codes for medical team conferences are:

  • 99366 — Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more, participation by nonphysician qualified health care professional
  • 99367 — Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by physician
  • 99368 — ...participation by nonphysician qualified health care professional.

 

While 99366 stipulates that the patient and/or a family member should be present during such conference, all the codes apply to nonphysician healthcare professionals (NPPs) as well. NPPs include a nurse practitioner, nurse, or a physician assistant. Codes 99366 and 99367 specify a minimum service time of 30 minutes.

 

 

Patient presence matters: Many payers, including Medicare, will not reimburse separately for non-face-to-face services — which means insurers likely will not recognize 99367 (during which the patient and/or family is not present) as a payable service. There is a possibility, however, that payers may choose to accept 99366 if an NPP in your practice takes part in a team conference for a patient in your care, as long as the patient and/or family is involved.

Code 99367 also requires a service time of at least 30 minutes but applies when a physician (rather than an NPP) participates in the team conference. In this case, the patient and/or family are not present.

 

 

Key an eye on payment: But don’t be too quick to assume carriers won’t pay for the new team conference codes. Medicare should be directed to pay separately for the medical team conferences CPT®/HCPCS codes [including new physician team conference codes] that involve coordinating patient care for which Medicare currently does not make separate payment.

 

 

Reporting advice: Documentation will be key when reporting team conferences. For each service, physician notes should specify:

  • Who participates in the conference (the specific providers with credentials). Remember, only one same-specialty, same-practice professional may bill per conference.
  • Time of participation. This must begin at the start of the review for an individual patient, and ends when that review is concluded. The service must deal with one patient at a time.
  • The patient’s presence (or lack thereof).
  • Plan going forward, to include:
  1. treatment goals
  2. what rehab treatment is prescribed (be specific)
  3. any referrals.

 

In an instance, when both the physician and the patient are present for a counseling service, the service should be reported with a standard E/M code (such as established office or other outpatient visit, 99211-99215) based on the counseling and coordination of care time. 

 

 

Hope this helps.

 

Thanks.

victor Posted Fri 14th of February, 2020 10:04:53 AM
Can a physician use the 99366, 99367 and 99368 or does this just apply to nurse practitioners?
SuperCoder Answered Mon 17th of February, 2020 13:20:20 PM

Hi,

The participating physicians report code 99367 when a team of physicians and possibly nonphysician practitioners spends an average of 30 minutes or more discussing treatment options. The patient is not present in the meeting.

 

A medical team conference is the face-to-face participation by a minimum of three qualified healthcare professionals from different disciplines/specialties who are directly involved in the care of the patient.

 

In your scenario above, it is not clear whether the other MD is from different speciality and directly involved in the care of the patient. Therefore, in billing medical team conference codes, the above criteria must be fulfilled. The article above provide some information regarding the same.

 

Also, when both the physician and the patient are present for a counseling service, the service should be reported with a standard E/M code based on the counseling and coordination of care time. 

 

Hope this helps.

 

Thanks.

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