E/M and Medical Team Conference??? Help!

[Danni R.]

Steve has said so many times, and I can only repeat, that there is no way we can know other state's laws (which can differ from state to state), which health insurance your doctor (the provider) is contracted with, other stipulations within his contract, whether he is a network provider, and most importantly, what is legal and what is not.

Steve also said many times: do your research, read the benefit manuals, check the Medicare website, speak with an insurance company representative directly to address specific concerns, and most importantly, stay within your scope of practice. You can find the information you need but you cannot make legal interpretations when you give the print-out to your supervisor.

The best way to sort this out is for you to find a more experienced biller within the hospital's billing department and go over the details with him/her one by one. It might just a very brief moment. Ask him/her to become your mentor so you can return when there are any more questions. If there is no one you can ask, and you are not comfortable accepting this task (since incorrect billing will ultimately reflect poorly on you!) it may be best to simply say: "It's a little over my head," and step back. I happen to believe that such specific billing questions are difficult to answer correctly in a forum. There are too many factors we don't know.

It may not be the answer you hoped for, but let's see if Steve can add something more constructive.

[Kellie.Salmon]

Hello everyone

I recently began working for a High Risk Infant F/U Clinic at a hospital facility. I was asked to do billing for the clinic until it can get up and running well enough to generate enough profit to talk the hospital into doing the billing. I dont mind doing the job with my experience but I have never billed for the types of services provided and need some advice as to how and what I can bill for.

The visit starts with the patient anywhere from 6mo to 3 years old being scheduled in our facility(High Risk Infants who normally have a CCS qualifying condition).

When they arrive I take vitals such as Weight,HC,HT, BP, Temp, Resp, a long history..etc etc.... The patient is then seen by the Hospital Neonatologist/Pediatrician for a very thorough examination, checking development etc (30-60 Mins), then is passed on to the OT for a Developmental screening using a Bayley Scale (45 Mins), The patient is then seen by the Nutritionist (15 min), and finally by a Case Worker/Social Worker (15 Mins). Once all of these exams are done the specialists and physician along with the patient/parent sit down for a round house discussion and plan of care and treatment.(15-30 Mins). Overall the patient is usually here about 2 hours total.

I am not sure what codes I can use legally in this situation to bill for the physician and the OT therapist. This is my thought:
Physician: 99205 or 204 depending on time and severity of the patients disability.
OT: 96111 or 96110?

But can I also bill a 99366 for the therapist and the physician or can the physician only bill the 99205? Is there anything else I could consider billing such as a Care Plan Oversight code?

Someone told me I could also bill a 75.00 fee for the physician as the clincal director and Im not sure how to do this.

Thanks so much for any help you may possibly offer me.

Kellie