Primary Care Coding Alert

Don't have time to attend that Individualized Education Plan (IEP)? You will soon be able to send a qualified nonphysician provider on your staff. CPT 2008 makes it easier to cover more team conferences -- you just have to let your staff attend.

Catch this: In 2008, you-ll look at more than time when coding medical team conferences. The AMA deleted the two-team conference codes (99361, Medical conference by a physician with interdisciplinary team of health professionals or representative of community agencies to coordinate activities of patient care [patient not present]; approximately 30 minutes; and 99362, - approximately 60 minutes). When choosing between the new team conference codes, zoom in on the provider and the patient.

If the conference involves the physician, and the patient and/or family is not present, you-ll use 99367 (Medical team conference with interdisciplinary team of healthcare professionals, patient and/or family not present, 30 minutes or more; participation by physician). "Physicians only get to do a team conference without a patient or family," says Peter Rappo, MD, FAAP, a practicing pediatrician and clinical professor of pediatrics at Harvard Medicine School in Boston.

Beware: The non-face-to-face restriction could be problematic, Rappo says. "Parents may want to be at an IEP to make sure the plan is in the child's best interest."

If you hold the IEP at the office and the patient and family are present, you should instead report office visit codes (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient -), using time as the controlling factor, if the physician spends more than 50 percent of the encounter counseling and/or coordinating care.

Idea: If a patient and/or his family wants to attend an out-of-office IEP, consider having a staff member attend in place of the physician.

Two new codes will open the door to nonphysician qualified healthcare professionals participating in team conferences. The professional could be almost anybody, such as a respiratory therapist or physical therapist, Rappo says. This seems odd because usually the physician is the team captain and would lead the conference, he says.

Don't overlook: Nonphysician practitioners (NPPs) will have more options. They can code face-to-face or non-face-to-face patient/family team conferences, Rappo says.

If the patient and/or family is present for the conference, choose 99366 (Medical team conference with interdisciplinary team of healthcare professionals, face-to-face with patient and/or family, 30 minutes or more, participation by nonphysician qualified healthcare professional). When the patient and/or family does not attend the meeting, use 99368 (Medical team conference with interdisciplinary team of healthcare professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified healthcare professional).

You won't have to do one thing that you had to with the 2007 team conferences codes: code based on time. The new codes are open-ended, for "30 minutes or more," meaning you will code the conference only once regardless of its length.

Difference: The 2007 codes were for "approximately 30 minutes" and "approximately 60 minutes." This language allowed you to capture additional time with prolonged services.

Example: A physician attends an IEP meeting for a hearing-impaired patient without the patient or her family. He spends a total of two hours in the team conference.

In 2007, you would have coded the conference with 99362 for the first 60 minutes of the team conference. For the second hour, you could have also reported a prolonged services code (such as +99358, Prolonged services without patient contact).

New way: You will be able to code the conference with only 99367. The single code will capture the entire conference's length. "This is quite a distinction from the previous codes," Rappo says.

Team conferences apply to much more than IEPs. "These are great codes to use that are really beneficial, especially when coordinating care of children with chronic conditions," Rappo says.

Open your eyes to the full use of these codes:

- Disorder management: When a physician -- or in 2008, a nonphysician qualified healthcare professional -- meets with a patient's teacher and the school psychologist to discuss the child's developmental and/or behavioral problems, such as ADD/ADHD, you may use team conference codes.

- Chronic conditions: A physician meets with all caregivers for a patient with a G-tube or ventilating tube about feeding issues for 30 minutes. Currently, you would code this based on time with 99361-99362. In 2008, you-ll use 99367.

- Abuse: Consider these codes for a team conference or meeting with Child Protective Services, police, or rape crisis counselors, suggests ChildabuseMD.com's article "Documentation: Coding for Billing." "Document time spent, people present, content of discussion, and plans for the patient," the article states.

Showing insurers the cost savings of a patient-centered medical home might convince them to pay for team conferences. "Insurers will only pay if they see the benefit," Rappo says.

Do this: Present a united front. That's how Massachusetts physicians won payment for current team conference codes.

"We bring up non-coverage issues through our medical society and pediatric council," which as a whole addresses insurers- code policies, Rappo says.