Pediatric Coding Alert

Question: Our physicians would like to perform group visits for about eight to ten patients at a time to counsel them on obesity. Should we report 97804? Or perhaps 99213 for each person in the group?

Answer: The best code would be 99078 (Physician or other qualified health care professional qualified by education, training, licensure/regulation [when applicable] educational services rendered to patients in a group setting [eg, prenatal, obesity, or diabetic instructions]) but payment could be unreliable depending on your insurer.

Most policies don’t cover 97804 (Medical nutrition therapy; group [2 or more individual (s)], each 30 minutes) for obesity - the child would have to have another diagnosis such as kidney disease or diabetes to warrant medical nutrition therapy, but check with your insurer on its specific policy. You can report 99213 if the patient is seeing the doctor one on one for the counseling, but not if the counseling is taking place in a group setting.