General Surgery Coding Alert

Question: Recently, our surgeon and several other specialists met for an hour to discuss treatment options for a severely injured patient. The patient was not present. Is this a billable service?

Michigan Subscriber

Answer: CPT provides two codes to describe the type of "team conference" you describe: case management 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). For Medicare patients, however, these services are not billable. The Medicare physician fee schedule database assigns no relative value units to these codes.

In addition, Medicare's Internet Only Manual, section 30.6.16, specifically instructs carriers, "Do not pay for team conferences (codes 99361-99362). Payment for these services is included in the payment for the services to which they relate."

In other words: Case management services are included in other E/M services the physician provides, or as a part of any other procedure that the physician bills.

You may, however, consider case management services -- defined by CPT as "a process in which a physician is responsible for direct care of a patient, and for coordinating and controlling access to or initiating and/or supervising other healthcare services needed by the patient" -- as a factor when determining an E/M service level, as long as the physician can document how the case management affects the key components of history, exam or medical decision-making when selecting the billed E/M service.

Note that private payers may specify different guidelines from those explained above, but you-ll want to be sure to get their recommendations in writing if they differ from Medicare's rules.

Change is coming: Early information suggests that CPT 2008 will delete codes 99361-99362, possibly to be replaced by three new codes (99366, 99367 and 99368). Whether payers will treat the new codes differently remains to be seen.