Correct Medical Billing For Group Visits

Correct Medical Billing For Group Visits

With the emergence of more and more group doctor appointments, medical billing processes have had to adjust. A group visit is when patients with similar diagnoses or background have a medical appointment for educational reasons. In these visits usually full history is taken and physicians may individually take out patients for decision making and treatment. There are several medical billing options for this type of visit.

Since group visits are fairly new, many medical billing staff members code it incorrectly. This miscoding can lead to payment denials. There are two main ways to code group visits.

One way to do medical billing for a group visit is to use CPT code 99499. This is when the physician reports for each specific service that is received in the group setting. Usually this is very limited since the service is in a group setting. When doing medical billing for this type of coding, documentation must reflect the medical necessity of the visit. The insurance company then goes through each claim and decides if the visit was medically necessary for each individual patient. This medical billing process is very tedious for all involved.

Perhaps a better way to do medical billing for a group setting is to bill only for the one-on-one contact a patient has with the physician. The physician only bills for the service that was done without the group. This means, for medical billing purposes, the group visit really is not mentioned in the evaluation and management encounter. It is done merely to save time on the physician’s end.

In order to recover the most accurate amount of money for group visits, it is necessary to provide proper coding. Be sure to double check the medical billing accuracy of all group visit claims before they get sent to payers.

View all Articles by: Melissa Clark, CCS-P