From:
"Knight, Eric" <EKnight@Elliot-HS.org>
To: "ihi-icop" <ihi-icop@ls.ihi.org>
Subject: [ihi-icop] RE: Billing for Group Visits
Date: Thu, 24 Mar 2005 09:10:08 -0500
X-Mailer: Internet Mail Service (5.5.2650.21)
List-Unsubscribe: <mailto:leave-ihi-icop-1973740F@ls.ihi.org>
Reply-To: "ihi-icop"
<ihi-icop@ls.ihi.org>
Our compliance people have expressed similar concerns, but we've had no problems using E&M codes as long as we check vital signs, document the topics of discussion in the group visit, and review each patient chart to determine if there are any routine labs or other measures of prevention and control that are due. If I don't spend any 1:1 time with the patient I bill it as 99212, and if we do have 1:1 time I use 99213 or 99214 depending on complexity. If by some chance we miss even getting vital signs, we have a 'dummy code' in Epic (our EMR) to document that they came for a diabetes group visit and there is no charge beyond the $5 copay we require.
Based on the documentation which is done, our compliance people agree that it's unlikely we will ever have a problem - although they would prefer that there could be a way of making the coding and billing more accurate.
-----Original Message-----
From: Gutierrez, Pete [mailto:Pete.Gutierrez@dhha.org]
Sent: Wednesday, March 23, 2005 9:43 PM
To: ihi-icop
Subject: RE: [ihi-icop] Billing for Group Visits
To our dismay CMS has refused multiple attempts to convince
them otherwise. Dr. John Scott, a geriatrician and pioneer in this field,
is on our staff in our Internal Medicine department at Denver Health. He
has made multiple trips to
Regards,
Pete Gutierrez
Service Line Adminstrator for Community Health
-----Original
Message-----
From: Kevin Taylor [mailto:km_taylor@msn.com]
Sent: Wed 3/23/2005 7:00 PM
To: ihi-icop
Cc:
Subject: [ihi-icop] Billing for Group Visits
We have been doing group visits for diabetes pts in for 2 years.
To bill for this we have been using a "Progress note" published in the Family Practice Management journal in June 2000. The web site for this article is: http://www.aafp.org/fpm/20000600/33plan.html. I am attaching the "Progress Note" document in Word for your review.
Essentially we bill E & M codes; a 99213 if no rx changes are made, a 214 if we make rx changes. The main
component of the billing is based on time in counseling.
Recently compliance managers in our organization have expressed concern about
this billing approach. They cite a CMS publication which is at this site:
http://www.aishealth.com/Compliance/ResearchTools/RMCMedicareBillingPossible.html
According to this report a CMS official states, "Medicare does not have
any existing payment or coding rules that directly address patients being seen
in a group setting," and the premise of CPT codes is a face-to-face
encounter between one patient and one physician, which leaves out the group
setting.
Our compliance managers are requesting that we not bill E&M codes unless we
see the pts one on one in an exam room. They request that we be certified as
diabetes education providers and meet the National Diabetes Advisory Board
Standards. Then we can bill an approved CPT code explicitly for diabetes group
sessions. We don't have time or interest in getting this certification and
believe our care delivery justifies an E & M code based on counseling and
one on one care.
I need help folks. I am looking at having to close down this
care delivery innovation that has been the most effective and life giving
experience for our providers and pts.
Anyone have other ideas on how to make group visits financially viable?
Kevin Taylor MD, MS
Director Quality and Primary Care Operations
St. Joseph Mercy Medical Group
km_taylor@msn.com
734-547-7929