Donna Posted Tue 17th of January, 2012 16:01:44 PM
Hi! I work for a multi-specialty practice and we are interested in billing Medical Team Conferences ('99366', '99367', '99368') and am not sure if we can. Does anyone have any advice on billing for these codes and if they are currently being reimbursed?
SuperCoder Answered Wed 18th of January, 2012 06:27:41 AM
Patient presence matters: Many payers, including Medicare, will not reimburse separately for non-face-to-face services — which means insurers likely will not recognize 99368 (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.
Previous codes 99361 and 99362 (Deleted on 01/01/2008) also described physician participation in a team conference, but because those codes specified patient not present, Medicare and other payers would not reimburse for the services. Because 99367 likewise is not a face-to-face service, payers will almost definitely not pay for it.
Key an eye on payment: But don’t be too quick to assume carriers won’t pay for the new team conference codes, some experts say. Congress and the American College of Physicians (ACP) are encouraging valuation of the new codes that advance the patient- centered medical home. Medicare should be directed to pay separately for the following CPT/HCPCS codes [including new physician team conference codes] that involve coordinating patient care for which Medicare currently does not make separate payment, according to an ACP statement presented to the U.S. House of Representatives Committee on Ways and Means.
Reporting advice: Documentation will be key when reporting team conferences. For each service, physician notes
1. Who participates in the conference (the specific providers with credentials).Remember, only one same-specialty, same-practice professional may bill per conference.
2. 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.
3. The patient’s presence (or lack thereof).
4. Plan going forward, to include:
a. treatment goals
b. what rehab treatment is prescribed (be specific)
c. 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.