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Billing for an educational class

Leah Posted Tue 24th of March, 2015 14:53:18 PM

Hello,
We have a PA-C who will be doing an out of office educational class about erectile dysfunction and post-prostatectomy expectations. It is in an educational center, and the groups of men consist of 15-20.
I was originally thinking of CPT 98962 for billing (even though the max is for 8 patients), but was informed that one of our physicians will be filling in for the PA-C when needed. Since 98962 is for a "non-physician," I found 99078, which sounded much more appropriate overall. I just want to verify if this would be the correct code for this scenario.

Thank you,
Leah
CPC, CUC

SuperCoder Answered Tue 24th of March, 2015 19:27:13 PM

Thanks for your question. Your billing choices will depend on whether the physician or the PA-C is doing the education and the number of patients being taught. 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) is not a time based code and would be an appropriate choice for the type of service you are describing. The other options would be 98961 and 98962, but these codes are not only time based but are also for non physician billing and are billed based on the number of patients being taught. See the attached article for additional information on these education codes.

https://www.supercoder.com/coding-newsletters/my-family-practice-coding-alert/reader-question-consider-patients-and-provider-for-99078-vs-98960-98962-108417-article

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