By April Borgstedt, CHC, CPC-I, CEMC, CPMA, CPC, CCA, FSA, CMC
Medical care in the 21st century incorporates a patient-focused approach, using a case-management team that meets in conferences to collaborate and develop a plan of care that benefits a long-term outcome for the patient. Historically, patients relied on family practice physicians with only generalized training to control disease within the communities. Scientific advancements and combined technology have provided insightful advantages to patients by providing healthcare workers with training in specialized disciplines. Vast options are now available from differing types of providers, treatments and medications, all equally contributing to the improvement in disease management, quality of life, and benefit to the patient.
The positive influence of care managers and medical teams floods the pocketbooks for many members, saving a bundle on health insurance due to participation in team medical care plans for wellness or chronic disease management. Some insurance companies that utilize such programs are Cigna and Blue Cross, each reporting record savings accredited to having team care programs focused on overall awareness and chronic health of their members. This has proven to be an effective technique to reducing costs to manage chronic illness, also playing a key role in improving patient outcomes or quality of life.
Disease management, specific treatment types and specialty services consultations are just a few of the services that collaboratively can be provided to benefit patients in a team conference setting. The participation of non-physician clinicians specializing in disciplines such as therapy, psychology, pharmacology and social work can provide a comprehensive report to the physician regularly. This helps the physician to focus on each patient with more timely information, enabling better medical decisions. This team approach delivers a precise plan of care, customized with appropriate feedback and timing to patients, caregivers and all clinical participants – an approach striving for the whole-person healing.
This is an empowering and innovative solution that is fueling a new wave of patient-centered care. Team conferences are more than a trend, being recognized in 2008 by the American Medical Association (AMA) as a billable service and published in the Current Procedural Terminology (CPT) manual. In 2008, the AMA clearly defined medical team conferences to be a “process in which a physician or another qualified healthcare professional is primarily responsible for the direct care of a patient, as well as coordinating, managing access to, initiating and supervising other healthcare services needed by the patient.2" The AMA adopted three new procedure codes (99366-99368) and assigned guidelines for reporting these services.
There are three procedure codes reportable for medical team conferences. One is encounters for medical team conferences with direct patient face-to-face contact in excess of 30 minutes (99366). Frequently, other medical team conferences lasting longer than 30 minutes occur, but do not have direct patient (face-to-face) contact. The procedure codes selection for no direct patient contact is determined on the basis of whether conference participation included a physician (99367) or a non-physician (99368). To recap, the medical team conference CPT codes are as follows1:
99366 Medical team conference with interdisciplinary team of healthcare professionals, face to face with patient and/or family, 30 minutes or more, participation by non-physician 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 Medical team conference with interdisciplinary team of healthcare professionals, patient and/or family not present 30 minutes or more, participation by non-physician qualified healthcare professional
The team conference time begins at the initiation or review and discussion of a patient, and ends at the conclusion of the review. The reporting participants must be present for the entire time reported.
No more than one individual from the same specialty may report procedure 99366- 99368 for the same encounter. Time related to record keeping and report generation is not reported. Time reported for medical team conferences may not be used in the determination of time for any other procedural service category orother E/M category.
PREREQUISITES AND DOCUMENTATION FOR TEAM CONFERENCES
Team conferences are subject to stringent guidelines under HIPAA, in addition to the specific requirements that must qualify the service for code selection and reimbursement under guidelines for performance and reporting of these services. Team conferences generally entail face-to-face participation of a minimum of three qualified healthcare professionals of different specialties or disciplines that have direct care for a patient. The team conferences must be supported by clinical documentation in the medical record by each participating clinician – independently as contributing to the coordination and presentation of illness, findings, options or recommendations from various disciplines and the formation of an integrated plan of care.
An interdisciplinary team conference is more comprehensive than the typical coordination of care or the counseling services provided to a patient directly by a physician. These disciplinary team participants must actively be involved in the development, revision, coordination and implementation of healthcare services needed and provided directly to the patient. Importantly, each participant must have previously seen the patient at a face-to-face encounter within the previous 60 days. Team conferences require a minimum of 30 minutes of treatment planning time per patient be spent by the participants, but do not allow reporting or documenting to be counted in the total time.
The diversity of this patient-centered healthcare model demands a team spirit of all clinicians – both in the absence and presence of the patient and/or the medical physician.
Team conference situations may be thought of as a new trend to managing chronic disease and improving overall wellness; but actually, this type of coordination in care has been included in the responsibilities of standard practice for some time. Only recently has the industry nationally recognized the value of specialty collaboration and begun to appreciate the workforce that is able to deliver this type of patient-centered care.
While the individual physician encounter with a patient remains the primary source of medical care for many, there is an emerging trend to deliver care using a medical team to formulate a comprehensive treatment plan encompassing various specialties, expanding the benefits of patient success. Medical team conferences qualify the work of multiple disciplines performing a variety of types of service simultaneously. The team conference procedure codes allow clinicians to receive compensation for their group work. The team conferenceenvironment is a bi-directional pathway for communication with patients and clinicians, and gives way for leadership to measure satisfaction, quality and compliance.
, president of Working for You Consulting, provides medical professionals with comprehensive practice analysis, educational solutions, and consulting services for compliance and revenue cycle management. Borgstedt is skilled in provider credentialing, payor negotiations and CMS billing requirements. Employed by Cancer Treatment Center of America since 2002 in her role as a senior compliance specialist, Borgstedt provides oversight of national audits, risk, and education to benefit physicians and staff. Borgstedt is a master at E/M auditing, as well as being certified by the AAPC as a licensed professional coding instructor since 2004. A leader in the Tulsa community, Borgstedt is currently president-elect for 2011 Pro-Tulsa AAPC Chapter, having served as new member officer in 2010. References: 1(2008, September). Coding Communication: Case Management Services. CPT Assistant, 18 (9), 2-3. 2AMA, (2011). Current Procedural Coding, Professional Ed. Salt Lake City: Ingenix.
1(2008, September). Coding Communication: Case Management Services. CPT Assistant, 18 (9), 2-3.
2AMA, (2011). Current Procedural Coding, Professional Ed. Salt Lake City: Ingenix.