Neurosurgery Coding Alert

Question: Recently, our neurosurgery 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.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno; and Gregory J. Przybylski, MD, AMA RUC member representing the American Association of Neurological Surgeons.