EM Coding Alert

Question: The patient underwent 99395 25, 81000, 58301-59, 99406 on the same day. How should I bill these codes?

Oregon Subscriber

Answer: You don’t need modifier 59 (Distinct procedural service) with 58301 (Removal of intrauterine device (IUD)). No bundling exists between any of these codes, so you should report:

• 99395-25 (Periodic comprehensive preventive medicine reevaluation 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, established patient; 18-39 years; Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service)
• 58301
• 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes)
• 81000 (Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy)

Keep in mind, however, that code 99406 has some very specific CPT^® criteria which must be met before this code can be billed, and that a routine UA is usually denied by the majority of payers as not medically indicated.