Wiki Using E/M 99213 for a shared medical visit?

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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?
 
This seems very incorrect. I would consider 99078, unless I had in writing from the carrier that they would accept 99211-99215 for group educational sessions.
Also keep in mind some insurances may not cover these services, or cover them only with very specific diagnoses.
 
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.
 
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,
Yes get approval from payers. But check out pages 825 to 826 in CPT manual year 2023. CPT 96164 health assessment& counseling for mental or medical illness in group atleast 15 minutes not more than 10 in group is the standard. Face to face for QHP ordered by /referred by MD, NP, DO, or PA or do video but add modifier 95. I would not use the CPT 99202- 99215 codes as suggested above.
I hope helped you somewhat.:)
Lady T
 
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.
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.
 
Right, I just thought it was interesting that a payer does cite the article in its policy. To be clear: The AAFP doesn't issue coding/reimbursement policy, and reporting on a statement from CMS isn't the same as direct confirmation from CMS. So even if the article had been written after the 2021 update, a practice can't rely on the article alone as permission to report group E/M visits as described.
 
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