How To Use CPT Code 99366

CPT 99366 refers to a medical team conference with interdisciplinary health care professionals, face-to-face with the patient and/or family, lasting 30 minutes or more, and involving the participation of nonphysician qualified health care professionals. This article will cover topics such as the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99366.

1. What is CPT 99366?

CPT 99366 is a medical billing code used to describe a specific type of medical team conference involving interdisciplinary health care professionals. This code is used when a patient requires care from multiple medical specialties, and a team of physicians and nonphysician qualified health care professionals must collaborate to develop a comprehensive treatment plan. The conference must be face-to-face with the patient and/or family and last for at least 30 minutes.

2. 99366 CPT code description

The official description of CPT code 99366 is: “Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more, participation by nonphysician qualified health care professional.”

3. Procedure

The 99366 procedure involves the following steps:

1. Identifying the need for a medical team conference due to the patient’s complex medical condition requiring care from multiple specialties.
2. Assembling an interdisciplinary team of physicians and nonphysician qualified health care professionals.
3. Scheduling a face-to-face meeting with the patient and/or family, ensuring that the conference lasts for at least 30 minutes.
4. Discussing the patient’s medical history, current condition, and treatment options among the team members.
5. Developing a comprehensive, documented treatment plan that addresses the patient’s needs from all relevant medical specialties.
6. Sharing the treatment plan with the patient, family, or caretaker, and addressing any questions or concerns they may have.

4. Qualifying circumstances

Eligibility for CPT code 99366 services depends on the following criteria:

• The patient has a complex medical condition that requires care from multiple medical specialties.
• The interdisciplinary team includes both physicians and nonphysician qualified health care professionals.
• The conference is face-to-face with the patient and/or family and lasts for at least 30 minutes.
• A comprehensive, documented treatment plan is developed and shared with the patient, family, or caretaker.

5. When to use CPT code 99366

It is appropriate to bill the 99366 CPT code when all the qualifying circumstances are met, and the interdisciplinary team conference is necessary for the patient’s care. This code should not be used for team conferences lasting less than 30 minutes or for conferences that do not involve the participation of nonphysician qualified health care professionals.

6. Documentation requirements

To support a claim for CPT 99366, the following information must be documented:

• The patient’s medical history and current condition, indicating the need for care from multiple medical specialties.
• The interdisciplinary team members, including their roles and specialties.
• The date, time, and duration of the face-to-face conference with the patient and/or family.
• A detailed account of the conference, including the topics discussed and the treatment plan developed.
• A copy of the comprehensive, documented treatment plan shared with the patient, family, or caretaker.

7. Billing guidelines

When billing for CPT code 99366, it is essential to follow the appropriate guidelines and rules. Ensure that all qualifying circumstances are met, and the necessary documentation is provided to support the claim. Additionally, be aware of any specific payer requirements or policies related to billing for interdisciplinary team conferences. Do not report CPT 99366 for the same time reported for other codes, such as 99424, 99425, 99426, 99427, 99437, 99439, 99487, 99489, 99490, or 99491.

8. Historical information

CPT 99366 was added to the Current Procedural Terminology system on January 1, 2008. There have been no updates to the code since its addition.

9. Similar codes to CPT 99366

Five similar codes to CPT 99366 and how they differ are:

• CPT 99367: This code is for a medical team conference without the patient and/or family present, lasting 30 minutes or more, and involving the participation of a physician.
• CPT 99368: This code is for a medical team conference without the patient and/or family present, lasting 30 minutes or more, and involving the participation of a nonphysician qualified health care professional.
• CPT 99487: This code is for complex chronic care management services, requiring a minimum of 60 minutes of clinical staff time per month.
• CPT 99489: This code is an add-on code for each additional 30 minutes of complex chronic care management services.
• CPT 99490: This code is for chronic care management services, requiring at least 20 minutes of clinical staff time per month.

10. Examples

Here are 10 detailed examples of CPT code 99366 procedures:

1. A patient with advanced cancer, requiring input from an oncologist, palliative care specialist, and a pain management specialist.
2. A patient with multiple sclerosis, needing care from a neurologist, physical therapist, and occupational therapist.
3. A patient with a traumatic brain injury, requiring the expertise of a neurosurgeon, physiatrist, and speech therapist.
4. A patient with a spinal cord injury, needing care from an orthopedic surgeon, neurologist, and rehabilitation specialist.
5. A patient with a complex diabetic foot ulcer, requiring input from an endocrinologist, vascular surgeon, and podiatrist.
6. A patient with a severe burn injury, needing care from a burn specialist, plastic surgeon, and physical therapist.
7. A patient with a complicated pregnancy, requiring input from an obstetrician, perinatologist, and neonatologist.
8. A patient with a rare genetic disorder, needing care from a geneticist, pediatrician, and specialist in the specific disorder.
9. A patient with a complex cardiac condition, requiring input from a cardiologist, cardiac surgeon, and electrophysiologist.
10. A patient with a severe mental health condition, needing care from a psychiatrist, psychologist, and social worker.