General Surgery Coding Alert

Question: Recently, our neurology practice began treating an aunt of one of the group physicians. Can we bill Medicare for these services, or are they excluded because the patient is a member of the physician's family?

Michigan Subscriber

Answer: Medicare will not reimburse a physician for services (including incident-to services) provided to members of his or her household or members of his or her immediate family, including services provided by a group practice of which the physician is a member. According to the Medicare Carriers Manual, section 2332, Medicare defines immediate family as husband or wife, natural or adoptive parent, child or sibling, stepparents, stepchildren, stepbrothers/sisters, father- or mother-in-law, son- or daughter-in-law and brother- or sister-in-law, grandparent or grandchild, and spouses of grandparents or grandchildren.

Therefore, assuming the physician's aunt is not a member of his household, she is not included in the "restricted" categories, and your practice may bill Medicare for services you provide.

Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS-P, CPC-H, HIM Program Coordinator at Clarkson College in Omaha, Neb.; and Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of Cash Flow Solutions Inc., a physician reimbursement consulting firm in Lakewood, N.J., and vice president of the Coding and Reimbursement Network.