Primary Care Coding Alert

Question: Is it appropriate to bill 99361 (Team conference) in addition to 99311-99313 (Subsequent nursing facility care)?


Colorado Subscriber

Answer: Probably not, particularly if you're billing the service to Medicare. The nursing facility care codes' descriptor states, "... counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem and the patient's and/or family's needs." Therefore, your family physician's daily E/M service includes meeting with other physicians and health professionals.

A typical subsequent nursing facility visit might include the FP's time with the patient, a review of her chart, a discussion with the charge nurse regarding the patient's behavior and/or interval history, and meeting with the rest of the patient's "team" of providers to discuss treatment plans and other issues.
 
You would include these items as part of the evaluation and management code. Choose the appropriate code 99311-99313 (Subsequent nursing facility care, per day, for the evaluation and management of a new or established patient ...) based on the history, examination and medical decision-making the FP documents.

Exception: You may, however, report the team conference codes (99361-99362) to commercial insurers if the FP coordinates the patient's care without visiting the patient that day. Medicare and Medicaid won't pay for any physician encounters that don't involve face-to-face time with the patient. But private payers may reimburse team conferences involving different specialists. Contact your insurer for its guidelines before reporting these codes.

For example, an FP meets with a psychiatrist, a physical therapist and a psychotherapist to discuss a fibromyalgia patient. Private insurers may pay for 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) with 729.1 (Mylagia and myositis, unspecified). 

Tip: Documentation should describe the meeting participants, the treatment plan, and proof of the time spent discussing the patient.