Insurers slow to reimburse for group visits

August 21, 2009

Third-party payers have been slow to adapt to group medical visits, meaning billing can be difficult.

Q: Some physicians in our primary care practice are interested in providing group medical visits. But the coding and billing of these services raise questions about reimbursement. Can you help us?

97804: Medical nutrition therapy, group (two or more individuals), each 30 minutes.

99078: Physician educational services rendered to patients in a group setting (such as diabetes instructions).

Drop-in group medical appointments (DIGMAs) must be billed with 99499 (unlisted evaluation and management service). Since this is an unlisted code, reimbursement will be left to the payer.

An E&M code (99201–99215) can be submitted for the individual patient examination performed by the physician during the one-on-one time normally held at the end of the group session.

The author is a compliance manager for Baptist Medical Associates in Louisville, Kentucky. Have a coding or managed care question for our experts? Send it to meletters@advanstar.com
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