Ophthalmology and Optometry Coding Alert

Come January, you'll be faced with several new and revised E/M codes. Because you're reporting so many E/M codes, save yourself a few headaches and dodge the potential denials by staying ahead of the coding curve.

Half the new E/M codes are replacements for codes removed from CPT 2008. For instance, medical team conferences codes 99361 and 99362 have been deleted and replaced by three all-new codes:

Codes 99366-99368 differ from their predecessors (99361 and 99362) in several ways. Most important, 99366 and 99368 apply to nonphysician healthcare professionals, such as nurse practitioners or physician assistants, says Susan E. Garrison, CHC, PCS, FCS, CCS-P, CPAR, CPC, CPC-H, executive vice president of Healthcare Consulting Services. All three code descriptors specify a minimum service time of 30 minutes or more, but 99366 also stipulates that the patient and/or family must be present during the conference.

Patient presence matters: Many payers, including Medicare, will not reimburse separately for non-face-to-face services -- which means insurers will likely not recognize 99368 (during which the patient and/or family are not present) as a payable service. Payers may choose, however, to accept 99366 if a nonphysician practitioner (NPP) in your practice takes part in a team conference for a patient under your care, as long as the patient and/or family is involved.

Code 99367 also requires a service time of 30 or more minutes, but applies when a physician also participates in the team conference. In this case, the patient and/or family are not present.

Previously, 99361 and 99362 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.

When to use the codes: Turn to the new team conference codes when your ophthalmologist works with other physicians to care for a patient. For example, a pediatric patient involved in an automobile accident requires the services of more than one specialist type to determine the best course and treatment plan. A meeting with the family, your ophthalmologist, a neurologist and plastic surgeon takes place to assess all issues involved in providing patient care and coordinating surgical services. Code this E/M service with the new team medical conference codes, says Maggie M. Mac, CMM, CPC, CMSCS, CCP, ICCE, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla.

Documentation will be key when reporting team conferences, Garrison says. She suggests that for each service, NPP or physician notes should specify:

1. Who participates in the conference (the specific providers with credentials). Remember, only one same-specialty, same-practice professional may bill per conference.

2. Participation time. This must begin at the start of the review for an individual patient, and ends when that review concludes. The service must deal with one patient at a time.

3. The patient's presence (or lack thereof).

4. Plan going forward, to include:

Caution: CPT 2008 does not contain a code for a team conference with both physician and patient and/or family involvement. In such a case (that is, when both a physician and patient are present for a counseling service), the physician should report a standard E/M code (such as established patient visit 99211-99215) based on counseling and coordination of care time, Garrison says.

"Be sure to alert your physicians," Garrison continues, "that counseling and coordination of care time must be documented."

More info: Read about the additional telephone and e-visit E/M codes in "Anticipate Easier Telephone Service Reporting Come January" in Ophthalmology Coding Alert, Vol. 10, No. 12.