99366-Need some insight


Belleville, MI
Best answers
Need some insight on 99366.

We see doctors billing this for when a case manager is at the E/M visit or when they visit a patient at their homes. Both being billed as often as on a weekly basis!

Correct me if I'm wrong, but isn't a doctor supposed to use an E/M code for these visits?

If they do qualify for 99366, can they bill 2 units for 60 minutes?

How often would 99366 be used and be considered 'reasonable and necessary'?

Very confused about the use of 99366!!!

Tina Boback CPC
99366 is for nonphysician qualified health care professional when there is a team conference of health care professionals (face to face with patient and/or family member). The doctors in this team must have performed a face to face evaluation or treatment of the patient, independent of any team conference, within the previous 60 days.

Your providers should be charging and E/M when the patient is seen at the office. If the provider is at the patients home you can look at codes 99374-99380.

Show your doctors the medical team conferences guidelines on page 33 of your CPT book if they need documentation.

Hope this helps. :)