Wiki 99366-Need some insight

[tboback]

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

 

[grth97]

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.