Medical Billing Forum

Coding => Coding => Topic started by: elizot on April 18, 2013, 08:39:45 PM

Title: Private Clinic O.T. CPT codes for parent conferences & team meetings
Post by: elizot on April 18, 2013, 08:39:45 PM
I am an occupational therapist and own a private pediatric clinic with several other psychologists and a speech therapist in CA.  We don't bill directly to any insurance companies but we give the parents a statement that includes the diagnosis and CPT codes so they can submit the claim to their insurance company.  When we do "team" evaluations, we each see the child separately for the eval then the clinicians meet for an hour to share our findings and collaborate on the recommendations.  Then we meet with the parents together to review the findings.  I typically bill CPT code 97003 for the 2 hour evaluation, 99368 for the 1 hour team meeting and 99366 for the 2 hour parent conference.  I've had parents say that their insurance company does not reimburse for 99368 and 99366.  I've been trying to figure out if there are any other codes I can use. 

Also, for treatment, I usually bill 97530 (OT to improve functional performance) for the full hour because this code is general enough to address all the areas I'm targeting during a treatment.  I had a client tell me that another OT clinic uses 4 separate codes for the hour because the reimbursement rate is higher-(e.g. 97530, 97110- therapeutic exercises, 97112- neuromuscular re-ed, 97535- self-care training).  I did it for her but found it incredibly time consuming in that I had to write separate descriptions under each of the codes in my note.  I'm wondering how common this is and what anyone's experience is with this.

Sorry for writing such a long post.  Any help any of you can give is greatly appreciated!
Title: Re: Private Clinic O.T. CPT codes for parent conferences & team meetings
Post by: Merry on June 20, 2013, 09:28:27 PM
Many commercial insurance plans do not even cover O.T and S.T..sad as it seems. I am confused why you are not each billing for the services that are provided. Did I misunderstand? If you, as an O.T see the patient, then you would bill for your services. What about the other providers that are seeing the patient? I understand about coordinating but are you doing all the billing under your NPI number? Are these other providers employees of the corporation? I would address this issue before I could help you with coding which is not my expertise.