Internal Medicine Coding Alert

Question: Our practice treats medium- to high-risk seniors with comprehensive healthcare problems. We use a primary care case-management system and team approach to evaluate, manage and coordinate care for multiple frail seniors. Our team is comprised of internists, general nurse practitioners, a pharmacist, a social worker, a nutritionist, and RN clinical coordinators. Can we use HCPCS code G0175 (interdisciplinary team conference) to report this service? It appears this code pays about the same as 99214. Does the use of this code require primary care physician involvement? What amount of team conference time is required, and what interdisciplinary team member participation is required by Medicare?

Steve Smelser
Med Max Health Management, San Diego

Answer: According to Nationwide Medicare, the Medicare carrier for Ohio and West Virginia, case management should be billed using codes 99361 (medical conference by a physician with interdisciplinary team of health professionals or representatives of community agencies to coordinate activities of patient care [patient not present]; approximately 30 minutes) and 99362 (... approximately 60 minutes). However, these services are not covered by Medicare but may be billed to the patient if you notify the patient in advance. The patient must sign a medical-necessity statement agreeing to pay for services not covered by Medicare. Nationwide Medicare said it had no record of code G0175 being reimbursed for this service.