Coding & Billing Q&A
Q: Recently I have been forced to commit even more time and resources to phone conferences and reviews for payment with the insurance company representatives including their reviewing clinicians. Is it true I can bill CPT code 99361 for meetings or teleconferences with other providers regarding a patient’s treatment?
A: Yes, but when has billing and coding ever been 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.
The problem here is the issue of patient “treatment”. The AMA CPT codes capture services provided in the care and treatment of a patient. They are not applicable for circumstances involving reimbursement policies or benefit determinations. In other words, as frustrating as it may be, the insurance company will be the first to tell you they are not trying to dictate care or treatment – only make benefit determinations.
While it seems obvious that such benefit determinations may affect care and treatment, ultimately that decision is always a patient-doctor one, and the insurance company is only deciding what is reimbursable.
I have heard a few doctors indicate they believed they could use this code, since on the surface it seemed applicable, but when you get down to the details, it is not. Please do not bill these codes for meetings or teleconferences with insurance company clinicians.
On an additional note, there is much work done by the ANJC and their supporting consultants on many fronts to advance the causes of practicing chiropractors in NJ – much of which you may not hear about. But with each accomplishment we achieve, more and more individual doctors are taking up the frustrating crusade to push back on the insurance companies regarding unfair business practices, policies and claim determinations.
As frustrating as it may seem to file an appeal or disagree with a claim determination, there is a larger picture here that we all must grasp. It is in the organized response to these injustices that is gaining ground and serving your profession, but more importantly it is the individual efforts that are needed to put names and faces on very real problems you see every day, and for which many may have become apathetic.
I can tell you first hand, that thankfully there are individual doctors, your peers and fellow members, who are serving your profession well by stepping up to the plate and fighting the good fight. Not by being creative and billing to get paid as opposed to being compliant, or by complaining the loudest; but by dotting their i’s and crossing their t’s so that when the ANJC needs to take a stand we have these doctors to serve as examples and foundations for us to make global points that will benefit the entire profession in NJ.
So the next time you get an e-mail from Sig asking about an issue with claim denials, policies, contracts, etc… - don’t hit delete and say “Oh just another e-mail from Sig and the ANJC”. Instead know that often we are asking for this not to just hear from you, but to have concrete examples to take a stand on behalf of all of you. The more you as an individual get involved and strive for compliance, the easier it is for us to hold the insurance companies feet to the fire when they stray from the rules or what is fair.
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John M. Kelly, AHFI, CPC serves as an in-house insurance consultant to ANJC and former senior investigator for Aetna insurance. He assists providers in education, billing & coding compliance, mock audits, and post payment audit dispute or defense. For more information contact Kelly Coding & Compliance at .