An update on the CPT codes from Debra Doyle, our colleague in the WA Department of Health:
January 1, 2008 marked the beginning of a new edition of CPT codes (registered trademark of the American Medical Association) and I wanted to alert you to a couple of new codes that may be helpful to you or your facility.
A) Medical Team Conferences
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 non-physician qualified health care professional.
Special notes: team conference services of less than 30 minutes duration are NOT reported and team conference services by a physician have a different Evaluation and Management (E/M) code.
99367 Medical Team Conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by physician (GCs won’t use this but it may be used by docs you work with)
99368 Participation by Non-Physician qualified healthcare professional.
Medical team conferences include face-to-face participation by a minimum of 3 qualified health care professionals (and genetic counselors and geneticists are specifically identified within the “for example” rationale) from different specialties or disciplines, each of whom provide direct care to the patient, with or without the presence of the patient, family member(s), community agencies, surrogate decision maker(s) (e.g., legal guardians and/or care givers). The participants are actively involved in the development, revision, coordination, and implementation of health care services needed by the patient. Reporting participants shall have performed face-to-face evaluation(s) or treatment(s) of the patient, independent of any team conference within the previous 60 days.
- MDs report their participation via E/M codes.
- Other reporting participants must document their participation in the team conference as well as their contributed information and subsequent treatment recommendations.
- No more than one individual from the same specialty may report 99366-99368 at the same encounter (yes – the geneticist and GC as would be viewed as from the same specialty).
- You should not report your participation in a team conference if your involvement is part of a facility or organizational service contractually provided by the organization or facility provider.
- The team conference starts at the beginning of the review of an individual patient and ends at the conclusion of the review. Time related to record keeping and generating a report is NOT reported.
- The reporting participant shall be present for all time reported.
- The time reported is not limited to the time that the participant is communicating to the other team members or patient and/or family.
- Time reported for medical team conferences may NOT be used in the determination of time for other services such as care plan oversight (99374-99380) prolonged services (99354-99359) psychotherapy or any E/M service.
- For team conferences where the patient is present for any part of the duration of the conference, non-physician qualified heath care professionals report the team conference face-to-face code 99366.
Sidenote: In thinking through this code, I spoke with many of you that come from varied clinical backgrounds and it seemed that these codes may be useful particularly for those of you that provide services in multidisciplinary clinics such as maxillofacial clinics, metabolic clinics, and neuro/ortho clinics – but I could also envision some perinatal centers that perhaps convene a multidisciplinary team when a prenatal diagnosis of an abnormality is made and multiple/diverse consultations are sought for the management/delivery/treatment of the infant.
B) Telephone and On-Line Medical Evaluations
Non-Face-to-Face Non-Physician Services – telephone and on-line medical evaluation.
98966 Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion.
98967 11-20 minutes of medical discussion
98968 21-30 minutes of medical discussion
Special notes: The patient must be an established patient.
98969 On-line assessment and management service provided by a qualified non-physician health care professional to an established patient, guardian, or health care provider not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network.
Special notes: Cannot be used for anticoagulation management. And again, it must be an established patient.
The rationale for these codes and their potential benefits are obvious – but just a reminder – having codes doesn’t necessarily translate into codes being paid for by insurers! Best we can do is keep trying to accurately articulate the services we’re providing and hope that they’ll be compensated.