How To Use CPT Code 99078

CPT 99078 describes the educational services rendered to patients in a group setting by a physician or other qualified healthcare professional. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 99078?

CPT 99078 can be used to describe the educational services provided by a physician or other qualified healthcare professional to patients in a group setting. This code is used when the healthcare professional conducts a class or other group educational activity to deliver instruction to participants. It is commonly used for patient education sessions such as diabetic teaching or prenatal classes for expectant mothers.

2. Official Description

The official description of CPT code 99078 is: ‘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).’

3. Procedure

1. The healthcare professional prepares and delivers instruction to participants in a group setting.
2. The educational activity can be a class or other group session focused on specific topics such as diabetic teaching or prenatal instructions.
3. The healthcare professional provides information and guidance to the participants, addressing their educational needs and promoting self-management of their condition.
4. The session may include discussions, demonstrations, and interactive activities to enhance the participants’ understanding and skills.
5. The healthcare professional may also answer questions and provide additional resources to support the participants’ learning.

4. Qualifying circumstances

CPT 99078 is appropriate when a physician or other qualified healthcare professional provides educational services in a group setting. This code is commonly used for classes or sessions focused on specific topics such as prenatal care, obesity management, or diabetic instructions. The healthcare professional must be qualified by education, training, licensure/regulation, and the services must be rendered to patients in a group setting.

5. When to use CPT code 99078

CPT code 99078 should be used when a physician or other qualified healthcare professional conducts educational services in a group setting. It is important to ensure that the services provided meet the criteria outlined in the official description. This code should not be used for individual education sessions, as there are other appropriate codes available for those scenarios.

6. Documentation requirements

To support a claim for CPT 99078, the healthcare professional must document the following information:

• A diagnosis related to the reason for education
• Evaluation and management (E/M) code for the office visit, with modifier 25 appended
• Date and duration of the educational session
• Topics covered during the session
• Participant attendance and participation
• Any additional resources provided to the participants

7. Billing guidelines

When billing for CPT 99078, ensure that the services provided meet the criteria outlined in the official description. It is important to include a diagnosis related to the reason for education and an E/M code for the office visit, with modifier 25 appended. Some payers may not reimburse for services included in CPT 99078, so it is important to verify contract terms and reimbursement policies. Even if reimbursement is not expected, reporting CPT 99078 to the insurance company for tracking purposes is recommended.

8. Historical information

CPT 99078 was added to the Current Procedural Terminology system on January 1, 1990. The code was later changed on January 1, 2013, to specify that it is for physician educational services rendered to patients in a group setting.

9. Examples

1. A physician conducting a prenatal class for expectant mothers, providing education on pregnancy, childbirth, and postpartum care.
2. A healthcare professional leading a group session on obesity management, discussing healthy eating habits, exercise routines, and lifestyle changes.
3. A physician delivering diabetic teaching to a group of patients, covering topics such as blood sugar monitoring, medication management, and dietary considerations.
4. A healthcare professional conducting a smoking cessation class, providing information on the health risks of smoking and strategies for quitting.
5. A physician leading a group session on stress management techniques, teaching relaxation exercises and coping strategies.
6. A healthcare professional conducting a group session on managing chronic pain, discussing medication options, physical therapy exercises, and alternative pain management techniques.
7. A physician providing education on heart-healthy habits to a group of patients with cardiovascular disease, discussing exercise, diet, and medication adherence.
8. A healthcare professional leading a group session on asthma management, teaching participants how to use inhalers, recognize triggers, and develop an asthma action plan.
9. A physician conducting a group session on healthy aging, discussing preventive care, exercise routines, and strategies for maintaining cognitive function.
10. A healthcare professional leading a group session on managing stress and anxiety, teaching relaxation techniques, mindfulness exercises, and coping strategies.