School/Work Form - 99080 and Medical Home Health

On a regular basis we fill out lengthy school forms after the patient has already had their office visit. I am coding the 99080 - my question is twofold: first, should I even bother with entering the code if it is a non-payable code (if it is) and secondly should I be submitting the 99499 with the 99080?

Also, we do a lot of Medical Home Health and Social Work. The APRN and LSW has lengthy conversations with many organizations in the process of setting up the correct care for our disabled children. Many hours on the phone coordinating care and then a home visit to make sure the family/patient understands the process and path the care needs to take for it to be successful. Please tell me there are codes that I can use that will explain all the work that is being done for these patients by the caregiver. They also do PPT and 504 Plans with schools that have disabled children.

Any help would be greatly appreciated. I am seeing double for all the reading and research that I have done on both of these topics only to always meet up with mixed reviews.

Thank you.

re: School/Work Form - 99080 and Medical Home Health

I would not use an unlisted E/M code, 99499 for these services.

99080 has a status indicator of B, bundled in the CMS Fee schedule. Any payer that follows CMS indicators will deny it as a bundled procedure. If a service is non-covered (by status indicator) you can bill the patient, but your private contractors will probably not allow you to do this.

As for the social worker services, unfortunately, you have to check with your private payers and state Medicaid to see if they can be credentialed. that will help with face to face services.

Case management also has CPT® codes. 99366-99368 for physician use. These have a status indicator of bundled.

Phone calls by a non-physician provider have codes 98966--98968. These have a status indicator of non-covered, so you could bill the patient, but I doubt an insurance will pay.

For your Medicaid patients, see if there are any programs for case management which will help.

In general, medical practices get paid for face-to-face visits with patients. This is a problem in Peds, I know, but I can't offer much help.