Forum - Questions & Answers

Aug 6th, 2015 - sdees

Billing E/M code 99366 by hospital non-physician staff

Here is another area in which I am getting some pushback and I need guidance. First of all I was under the belief that an E/M code should be billed on a CMS1500, but I am getting pushback saying that this is incorrect.

Here is the scenario. During an audit of a high dollar inpatient claim for a newborn, the itemized statement revealed charges for "team conferencing, non-physician, face to face with patient/family" and CPT® code 99366 was referenced. The charge was billed on a UB04 under Revenue Code 0420. 0430, and 0440. The personnel are hospital employees in Physical Therapy, Occupational Therapy and Speech/Language Therapy. I am told that these employees of the hospital do not have NPI numbers.

Is it appropriate to bill for this service in this manner?

Thank you,

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