CODING & DOCUMENTATION

Your ability to bill for your time depends on the clinical indication for the service. The time you spend supporting an appeal to an insurance company is typically not billable. But participating in a multidisciplinary meeting to discuss a child's medical needs and necessary accommodations is clinically indicated and billable using codes for team conference participation by a physician without the patient/family present (usually CPT code 99367, which requires 30 minutes spent in review of the individual patient).

When applicable, you may alternatively include your time in these meetings within bundled services covered by Medicare such as principal care management, chronic care management, or advanced primary care management. Note that non-Medicare health plans (especially Medicaid managed care plans) may have their own requirements for reporting these services. Your documentation should explain the indication for your participation in the meeting, how you participated (e.g., your recommendations), and your total time spent from the beginning to the end of the review and discussion of the individual patient.

Yes. While a patient's ASCVD risk management plan may include quitting tobacco, per Medicare policy the physician's time spent counseling the patient on tobacco cessation can be separately reported with 99406 for more than three minutes or 99407 for more than 10 minutes.

Other separately reportable services in this scenario could include the patient's self-measured blood pressure monitoring (99473 and 99474) and intensive behavioral therapy for cardiovascular disease (G0446). It's best to distinctly document each service you're billing for.

This depends on how long the interprofessional consultation was, whether it took place on the same date that you provided an E/M service to the patient, and whether you selected your E/M code based on total time or medical decision making (MDM).

If you spent at least 16 minutes consulting the subspecialist on a different date than the date when you provided the E/M service to the patient, then you can report code 99452.

But if you consulted the subspecialist on the same date that you reported an E/M service to the patient and you selected your E/M code based on total time, then you should include your time spent in the interprofessional consultation in the total time used to select your E/M code level and not separately report 99452.

If you used MDM to select your E/M code, the work of the consultation service contributes to the level of MDM regardless of the date when it occurred. So again, you should include it in the E/M level and not separately report 99452.