Group Medical Services: How to Code and Bill Shared Appointments

It is a growing trend in the medical industry for physicians to offer group medical services. Group medical services, also known as shared medical appointments (SMAs), are visits between a doctor and a group of patients with similar medical conditions. SMAs represent a new type of educational environment through which the quality of care a patient receives is supposed to grow. Instead of having a one-on-one consultation with a physician that lasts 15 minutes, a patient can elect to join an hour to hour and a half long group visit.

About Group Medical Services or SMAs

Group medical services allow a physician to see and potentially treat more patients because a doctor’s schedule can open up considerably for more one-on-one appointments. Additionally, the patients get better treatment because they have the opportunity to learn from one another about the chronic condition in question. And the practice need not be concerned with losing insurance reimbursement, as each individual patient is still filed separately. But how does this billing and coding work?

According to the American Academy of Family Physicians (AAFP), the Center for Medicare and Medicaid Services (CMS) states that “a physician could furnish a medically necessary face-to-face evaluation and management visit (CPT code 99213 or similar code depending on level of complexity) to a patient that is observed by other patients. From a payment perspective, there is no prohibition on group members observing while a physician provides a service to another beneficiary.”

How to Code Shared Medical Appointments

CMS asserts that any group medical services in the SMA do not affect the code recorded for the individual patient’s service. Each patient in an SMA should have some individual consultation. Patient billing should be handled on an individual basis, as regulated by the code for that patient’s individual level of care received during the SMA. Furthermore, each individual’s medical report should document both the group care and individual care provided during the SMA.

More than 12.7% of family physicians now offer group medical services. Whether or not your practice chooses to offer this option depends on your physicians’ style of service as well as patient needs. Group medical services such as SMAs can diversify your outreach, but the coding and billing may seem too complicated. If your practice becomes tangled in the codes and subsequent documentation, consider outsourcing your medical billing needs to Billing Advantage. By outsourcing, you can focus more on patient outreach and still get paid for the work you do. Visit the Billing Advantage website to learn more.