Ophthalmology and Optometry Coding Alert

There's 1 scenario the new codes won't cover -- we'll tell you what it is 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: • 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 • 99367 -- Medical team conference with interdisciplinary team of healthcare professionals, patient and/or family not present, 30 minutes or more; participation by physician • 99368 -- ... participation by nonphysician qualified healthcare professional. Take Note of Old vs. New Differences 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 [...]