Neurosurgery Coding Alert

Know which circumstances might warrant the use of this preventive measure.

Neurosurgeons, like most providers, can and should perform various types of preventive care services when the provider deems them necessary.

Problem: Many providers and office staff alike are not fully aware of the circumstances under which preventivecare measures can be taken. Similarly, they may not know the full range of services available at their disposal.

Read on for everything you need to know about coding for obesity screening and counseling in a neurosurgery practice.

Consider Specialty as First Factor

Specialty is one determining factor in deciding which preventive services are available to a provider.

"For instance, a radiologist may bill for preventive imaging screenings, but not typically for any type of consultations," explains Barry Rosenberg, MD, chief of radiology at United Memorial Medical Center in Batavia, New York. A cardiologist, on the other hand, may have the option to perform both preventive imaging procedures, blood screenings, and consultations.

As for the neurosurgery specialty, a provider's options are somewhat more limited than a specialty like cardiology, but it's still important that neurosurgery providers be aware of the situations in which they can (and sometimes, should) initiate a preventive care screening or consultation for Medicare patients. Providers may want to consider counseling patients on obesity and weight loss, when the circumstances call for it. However, there are numerous different guidelines physicians and coders must consider when determining when and how to code this preventive measure.

Consider Obesity Screening Measure

While there aren't any neurosurgery-specific preventive measures to report, providers should be aware of the option to counsel patients on obesity and weight loss as it pertains to their underlying symptoms and/or diagnosis.

Depending on the patient's symptoms and/or conditions, the provider may feel the need to counsel the patient on the dangers of their weight as it relates to their diagnosis. There are numerous examples in which obesity can complicate a patient's diagnosis. "Patients with GERD or respiratory issues, for example, are often counseled to lose weight if overweight or obese," says Jennifer M. Connell, CPC, CENTC, CPCO, CPMA, CPPM, CPC-P, CPB, CPC-I, CEMA, owner of E2E Health Solutions in Victoria, Texas.

Most commonly, as it pertains to neurosurgery, obesity has been known to be a complicating factor for surgical procedures - particularly the healing process - in addition to the administration of anesthesia.

As you will see, however, physicians must have a clear understanding of when and how to report the circumstances in which they opt to counsel a patient for weight loss.

Obesity Counseling Differs from Tobacco, Alcohol Use Counseling

While all alcohol use, tobacco use, and weight loss counseling have individual CPT^® codes a provider may report, it's important to understand what situations allow for a provider to report a specific counseling code. Consider the following weight loss counseling CPT^® codes:

• 99401, preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 15 minutes
• 99402, preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 30 minutes

Some coders may assume that they may bill these codes separately from a patient's evaluation and management (E/M) consultation. While you may report tobacco and alcohol use cessation counseling codes with an E/M visit, the same cannot be said for obesity counseling codes.

"CPT^® codes 99401 and 99402 do have a 'separate procedure' designation, which means that they are included in a more comprehensive service performed during the same encounter/same day. So, you would not bill a problem-focused E/M service and 99401 or 99402 on the same day," explains Connell.

"In fact, CPT^® states that 'risk factor reduction services are used for persons without a specific illness for which the counseling might otherwise be used as part of treatment.'  These codes [99401-99404] are not to be used when the counseling is provided as part of the treatment for an illness," relays Connell.

Note: You will not use the HCPCS codes G0446, G0447, G0473, which are designated for primary care providers using the intensive behavioral therapy (IBT) technique to counsel patients.

Meet the Criteria for Weight Loss Counseling

The patient must be found to have a body mass index (BMI) of 30 or more if the provider wishes to perform weight loss counseling, either in conjunction with an E/M visit or as a separate visit altogether. »

Remember: Determining a patient's BMI is also useful as a means of reporting Merit-based Incentive Payment System (MIPS) measures. However, in order to document MIPS measure #128, make sure you have reached the denominator criteria. This includes an age of 18 or above and the patient presenting for one of the following codes: 90791, 90792, 90832, 90834, 90837, 96150, 96151, 96152, 97161, 97162, 97163, 97165, 97166, 97167, 97802, 97803, 98960, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, D7140, D7210, G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447. While MIPS reporting is exclusive to patients ages 18 and up, physicians can still counsel and bill for patients on weight loss under the age of 18.

For eligible Medicare patients who meet the BMI criteria for weight loss counseling, Medicare will reimburse for:

• One face-to-face visit every week for the first month;
• One face-to-face visit every other week for months two through six; and
• One face-to-face visit every month for months seven through 12, if the member meets the 3-kg (6.6-lb.) weight loss requirement during the first six months.

When providers opt to include weight loss counseling as a part of the E/M visit, they may want to consider using time as the determining factor for E/M code choice, as the time the physician spends counseling the patient may place them in a higher coding bracket.

Caveat: Choosing E/M codes based on time is tricky; check with your provider and coding manager before coding an E/M based on encounter time.