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I have a cardiology group that wants to provide educational sessions in a group format to 8-12 patients and bill these as a 99213? What are your thoughts?
Hi MHackett,I have a cardiology group that wants to provide educational sessions in a group format to 8-12 patients and bill these as a 99213? What are your thoughts?
That's a very interesting side step by CMS on that question. It seems they are saying if you are providing the elements of a 99213 (2 of 3 low problem, low data, low risk) to a specific patient while it is being observed by other patients, you may bill that first patient for a 99213. It does not state you may bill the other patients who are only observing. It also states the group activities do not impact the level of coding. So for example, you cannot count educational group discussion time.Hi there, I agree that you definitely want to get approval in writing from the payer or MAC before you bill. I found a BCBS NC policy on group visits www.bluecrossnc.com/sites/default/files/document/attachment/services/public/pdfs/medicalpolicy/group_visit_shared_medical_appointment_guidelines.pdf . The BCBSNC policy cites an undated, but pre-2021 AAPC article that includes a CMS answer to a question about group billing. https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/group-visits.html
I would avoid saying the visits will always be coded at a certain level, even if you're using time. A session might end early, or run long.