Eli's Rehab Report

Question: In the last issue of Physical Medicine & Rehab Coding Alert, I read about the new medical team conference codes (99366 and 99368) that PTs, OTs and SLPs can report as "nonphysician qualified healthcare professionals." Does CPT consider PTA or OTAs nonphysician qualified healthcare professionals, and can they bill for these codes? Also, the article said that "at least three qualified healthcare professionals from different specialties and that have provided direct care to the patient must appear at the team conference and be actively involved in coordinating the patient's care." Can PTAs or OTAs count toward this requirement?

Missouri Subscriber

Answer: Experts do not recommend billing for a PTA's or OTA's time because CPT does not specifically mention assistants in its list of nonphysician qualified healthcare professionals. (See CPT 2008 Changes: An Insider's View for a full list of professionals that may bill this code.) It wouldn't hurt, however, to check with individual payers' interpretations of these CPT guidelines, especially private payers or workers' comp and auto insurance.

As to whether you can count a PTA or OTA toward the "at least three qualified healthcare professionals from different specialties" requirement, you should exercise the same discretion. According to experts at the American Physical Therapy Association, PTAs [and OTAs] cannot participate in medical team conferences. First, the CPT language states, "nonphysician qualified healthcare professional" as the basis for participants, and the heading language notes that the team conference "participants are actively involved in the development, revision, coordination, and implementation of healthcare services." That would mean that judgment and decision-making are required for establishing the ongoing plan of care, which is not part of the PTA [or OTA] duties, APTA interprets.