Primary Care Coding Alert

Question: Our physician wants to implement group patient education meetings, when he'll bring together several patients with the same diagnoses for an educational lecture/meeting. He suggested we could bill with 99078. What's your advice?

Kansas Subscriber

Answer: The appropriate code choice depends on how your provider structures the meetings and how many patients are present.

Option 1: If the physician plans and presents the information, you can submit 99078 (Physician educational services rendered to patients in a group setting [e.g., prenatal, obesity, or diabetic instructions]) as he suggests. Note that 99078 is not a time-based code and can be submitted for each patient present during the session. Not all payers reimburse for 99078, however, so check guidelines before making assumptions regarding payment.

Option 2: If a non-physician provider leads the session, you'll report different codes based on the number of patients present. Choices include 98960 (Education and training for patient self-management by a qualified, non-physician health care professional using a standardized curriculum, face-to-face with the patient [could include caregiver/family] each 30 minutes; individual patient), 98961 (... 2-4 patients), and 98962 (... 5-8 patients). Note that the training must use a standardized curriculum in order to report these codes, although you may modify the curriculum, as needed, for the clinical needs, cultural norms, and health literacy of the patient(s).