Internal Medicine Coding Alert

Question: How would you code for overseas travel advice, especially infectious disease prevention and general well-being?

Anonymous ICA Subscriber

Answer: This will depend on the reason the patient came to you in the first place. Is this counseling done in conjunction with a visit to monitor or treat one or more of the patients problems? Or was it purely a preventive health care encounter? If it is the latter, there are a number of CPT codes for preventive medicine services that you could report. These are broken down according to the patients agefrom 99381 for infants all the way to 99387 for 65 years and over for new patients, and 99391-99397 for established patients.

Medicare will not pay for preventive medical visits, although other insurance companies will, especially HMOs. However, if the patient is coming in to have you monitor or treat a medical problem and you end up spending a lot of time counseling her about her upcoming overseas vacation, even if shes in Medicare, you have a legitimate coding option: When more than 50 percent of the time spent during an encounter is dominated by counseling or coordination of care, you can bill that patient purely on the basis of CPT time.

Lets say an established patient came in to have her blood pressure monitored and her prescriptions reviewed and updated. But, during the course of that visit, she had a lot of questions regarding her overseas travel, and you ended up spending 20 minutes of a 35-minute encounter counseling her on how to take care of herself in a foreign country. The diagnosis code for this visit would be hypertension. The CPT code would be 99214, a level four established patient visit, determined strictly by the amount of time you spent in counseling. For your documentation records, you should describe all the services provided and also indicate the total amount of time you spent during the encounter and the amount that was dedicated to counseling.