Neurology & Pain Management Coding Alert

Question: We wish to employ a nutritionist to advise our patients regarding stroke prevention, evaluate and manage patients regarding lifestyle changes, and counsel overweight stroke patients regarding weight loss. How do we code for the nutritionists services? His credentials include a PhD in nutrition.

Virginia Scruggs
Orangeburg, S.C.

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Answer: Use the preventive medicine, individual counseling codes (99401-99404), and the preventive medicine group counseling codes (99411-99412), advises Catherine A. Brink, CMM, CP, president of Healthcare Resources Management Inc., a practice management and reimbursement consulting firm in Spring Lake, N.J., that consults with several neurology practices.

Code 99401 is for preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes. Code 99402 is used for counseling sessions of approximately 30 minutes, 99203 for counseling sessions of approximately 45 minutes, and 99404 for counseling sessions of approximately 60 minutes.

Code 99411 is for preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes. 99412 is for counseling sessions of approximately 60 minutes.

Brink refers to the Counseling and/or Risk Factor Reduction Intervention for new or established patients in the CPT 2000 manual and states that the guidelines in this section indicate that these codes should be used to report services provided to individuals at a separate encounter for the purpose of promoting health and preventing illness or injury. Preventive medicine counseling and risk factor reduction intervention provided at a separate encounter will vary with age and should address such issues as family problems, diet and exercise, substance abuse, sexual practices, injury prevention, dental health and diagnostic and laboratory test results available at the time of the encounter.

The preventive medicine individual counseling codes (99401-99404), and the preventive medicine group counseling codes (99411-99412) should be used only for counseling patients who do not have identified symptoms or established illnesses.

For counseling patients with symptoms or established illnesses, use the appropriate office, hospital or consultation, or other evaluation and management (E/M) code. If the counseling comprised more than 50 percent of the entire encounter, the neurologist could base the E/M level upon the time spent with the patient. The neurologists notes and documentation should demonstrate clearly that weight loss was discussed with the patient and that weight loss may help ease some of the patients symptoms. The amount of time spent counseling the patient and the total amount of time spent in the encounter should be documented also. For counseling groups of patients with symptoms or established illness, use code 99078 (physician educational services rendered to patients in a group setting [e.g., prenatal, obesity, [...]