Billing Interdisciplinary Rehab Team Conferences

Question: Aside from the billing code for daily personal contact with the patient and notations in the patient’s record and occasional conferences with a family member, please advise me regarding the appropriate E&M code(s) for weekly conferences with the rehabilitation team members assuming an average of 10 minutes per patient. Also, should the daily visit not be billed on the same day as billing for the rehabilitation team conference?

Answer: This response comes from Michael D. Miscoe, CPC, CHCC, an advisory board member for the American Academy of Professional Coders:

This appears to be a two-part question.

• What is the correct code for the physician’s participation with the interdisciplinary rehabilitation team, where the purpose of the conference is to review patient progress and the physician’s participation is not only direct care of the patient but to coordinate the rehabilitative care of the patient?

• How do you correctly document the need for these services?

The coding issue is simple. CPT 99361 and 99362 are appropriate and described, as follows, in the AMA Current Procedural Terminology Manual (4th ed., 2008):

“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.”

“99362 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 60 minutes.”

Note that according to the preface information in CPT, the physician participating in the team conference must have a direct treatment responsibility for the patient: “Physician case management is 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.”

The medical necessity issue is somewhat more difficult and is dependent on how the particular carrier/plan being billed defines the term. Generally, the item or service must be necessary for the diagnosis or treatment of a patient’s injury, illness, disease, or defect. With respect to the physician’s participation in the team conference and reporting of the team conference code, not only should the documentation reflect the physician’s involvement, but it should specifically reflect the treatment decisions made as a result of the conference.

Simply sitting and listening to the progress reports of the team members - while properly described by CPT 99361 or 99362, depending on the time involved - does not indicate that the physician performed any service necessary for the diagnosis or treatment of the patient’s condition. As a result, the need for the service becomes evident where information submitted indicates that the physician made specific recommendations or coordinated care in a manner to ensure that the patient’s condition was being appropriately treated.

Even assuming proper documentation, some carriers - including Medicare (see Medicare Claims Processing Manual, Pub 100-4, Ch. 12 §30.6.16) - will not pay for this service. The provider should validate coverage for this service prior to forming an expectation of payment.