Ob-Gyn Coding Alert

Counseling time also includes time spent with the parties who have assumed responsibility for the patient's care or decision-making. But remember, Medicare and most third-party payers do not pay for family education without the patient present. For example, if a family member wants to talk to the ob/gyn concerning home care of the patient's endometrial cancer (182.0, Malignant neoplasm of body of uterus; corpus uteri, except isthmus [includes the cornu, fundus, endometrium and myometrium], or 182.1, Malignant neoplasm of body of uterus; isthmus [lower segment of the uterus]), Medicare requires the patient to be present in the room with the family member.

"The physician should document the total visit time and how much of that time was spent counseling/coordinating care," says Carol Pohlig, BSN, RN, CPC, reimbursement analyst for the department of medicine at the University of Pennsylvania in Philadelphia. "The physician should also comment on the important issues discussed with the patient in addition to any relevant clinical information (e.g., patient response)."

You should remember that only the physicians time spent counseling the patient can be counted toward counseling/coordination of care time. Time spent by the ob/gyns staff on the patients case is not reportable.

And the code you choose will depend on the counselings nature. For example, if the counseling relates to a problem such as unresolved abdominal pain (789.0x) or viral warts (078.10), you should choose a level of service based on time from the outpatient E/M visit codes (99201-99215).

For instance, the ob/gyn spends 20 minutes with an established patient discussing treatment options for her viral warts, which were diagnosed during a previous visit. The physician does not perform a physical examination. Based on the counseling time involved, you should report 99213 (Office or outpatient visit for the evaluation and management of an established patient Physicians typically spend 15 minutes face-to-face with the patient and/or family) linked to the viral warts diagnosis (078.10).

Mary I. Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc., recommends the following acid test for compliant documentation when billing based on time:

1. Does the documentation reveal the total face-to-face time in the outpatient setting or on the unit/floor in the inpatient setting?

2. Does the documentation describe the content of the counseling or coordination of care?

3. Does the documentation reveal that the physician spent more than half of the time counseling or coordinating care?

If all the answers are "Yes," you should specify total encounter time (in minutes).

However, if the patient does not have any signs, symptoms or problems acute or chronic, stable or unstable and the counseling concerns health maintenance or prevention (in the absence of disease or injury), such as preconceptual counseling, you should report one of the "Preventive Medicine, Individual Counseling" codes (99401-99404).

For example, an asymptomatic patient comes to the ob/gyn because she has a family history of ovarian cancer. The doctor spends 30 minutes discussing the risks and preventive actions the patient can take to reduce her chances of personally developing ovarian cancer. In this case, you should report 99402 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 30 minutes) linked to V16.41 (Family history of malignant neoplasm of genital organs, ovary).

Typically, however, Medicare does not reimburse for 99401-99404. Some private payers do, but generally only to primary-care physicians (PCPs). If your ob/gyn is not a credentialed PCP with the insurer, the preventive counseling likely will not be paid.