Ob-Gyn Coding Alert

Tip: Avoid using 99401-99404 if the patient is ill.

If you’re not reporting preventive medicine counseling codes 99401-99404 on the same day as a problem-based E/M visit when your ob-gyn counsels the patient on an unrelated issue, you could be missing out on reimbursement up to $117.

First, Study Preventive Medicine Codes

If the patient sees an ob-gyn just for counseling and does not have an established illness, you should use one of three codes, depending on the counseling sessions duration:

• 99401 (Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes)
• 99402 (... approximately 30 minutes)
• 99403 (... approximately 45 minutes)
• 99404 (... approximately 60 minutes)

Note: Based on the Medicare conversion factor of $36.0896 per RVU, 99401 pays about $40, while 99404 pays about $117.

According to CPT^®, counseling codes apply when a physician counsels on 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.

Caution: In other words, the purpose of the visit must be promoting health and/or preventing illness or injury. If the patient is ill, you shouldn’t use the preventive counseling codes. CPT^® clearly states that you should not use these codes when counseling patients with symptoms or an established illness, says Peggy Stilley, CPC, CPC-I, CPMA, CPB, COGBC, Senior Education Specialist for the AAPC.

For example, use a counseling code when the doctor provides counseling on diet and exercise for a well patient who wants to lose weight, but not when the doctor provides the same services to a diabetic.

Try Your Hand at These 3 Scenarios

Learn how to determine which code to report by taking this three-scenario challenge.

Scenario 1: The ob-gyn spends 20 minutes discussing and prescribing birth-control pills during a preventive medicine counseling session with an adolescent patient. What should you report?

Scenario 2: An established patient presents to your ob-gyn and wants counseling as to whether she should have the HPV vaccine. Once she learns about its benefits, she wants to have the vaccine on the same day. What should you report?

Scenario 3: Your ob-gyn sees a patient for urinary incontinence (N39.3- or N39.4-) and then spends time counseling the patient on continued use of hormones with SUI. What should you report? Have your solutions? Turn to page 5.