EM Coding Alert

Question: The physician saw a 21-year-old female patient for a general adult exam and contraceptive management. The physician spent 50 minutes face-to-face with the patient, and about 30 minutes of that was spent on counseling. I originally chose 99385, but I am being asked if we can also bill 99402?

Iowa Subscriber

Answer: The correct choice in this case is 99385 (Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years).

Code 99385includes "counseling/anticipatory guidance/risk factor reduction interventions which are provided at the time of the initial or periodic comprehensive preventive medicine examination," according to the CPT^® manual. So, since 99385 already includes the counseling/anticipatory guidance, you cannot bill 99402 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 30 minutes), as well.

The CPT^® manual adds that if the physician reports counseling/anticipatory guidance/risk factor reduction interventions at an encounter separate from the preventive medicine exam, then you could look to a code like 99402.

If the contraceptive management was for a specific issue that presented, depending on the documentation, the physician may consider reporting an Evaluation and Management (E/M) visit code instead of the preventive. However, in this case, a co-insurance and deductible might then come into play.