Ob-Gyn Coding Alert

Did the ob-gyn provide counseling? Find out how to account for this.

Do you know when you should code a contraceptive service encounter as a periodic preventive service or when you should consider it a risk factor intervention? This often-elusive answer will determine what you should report.

So, we rounded up four common myths about coding for these encounters to help you separate the fact from the fiction surrounding the correct coding choices for contraception services.

Myth 1: When a Patient Requests Contraceptive Services, You Should Code for a Preventive Service Visit.

For many ob-gyn patients, contraceptive discussion without a procedure is typically performed during a preventive medicine service exam. This means you would report 99384/99394 (Initial/Periodic comprehensive preventive medicine evaluation and management of an individual …; adolescent (age 12 through 17 years) or 99385/99395 (… 18-39 years), bearing in mind that you shouldn’t separately report the discussion from the preventive service visit.

However, if it is a standalone service, the counseling should be reported under the Preventive Medicine Counseling Service codes, experts say. So, if a patient comes to your ob-gyn and requests counseling prior to receiving contraceptive services, and “if only counseling is performed with development of  a contraceptive plan, the coding would be 99401-99404 [Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual …],” says Jan Rasmussen, PCS, CPC, ACS-GI, ACS-OB, owner/consultant of Professional Coding Solutions in Holcombe, Wisconsin.

The exact code would be “based on time spent face-to-face,” Rasmussen reminds coders. But, “many insurances may not cover 99401-99404 preventive counseling,” so it is important that you check with your payer beforehand, Rasmussen cautions.

Myth 2: During a Preventive Service Visit, You’ll Use 99401-99404 for the Counseling.

The confusion over this myth seems to stem from the wording of the descriptors. Because 99401-99404 contain the words “preventive medicine,” it is tempting to see them as additional codes for 99381-99397. But, “preventive services 99381-99397 include counseling, which may not be separately billed,” Rasmussen tells coders. This agrees with the CPT^® guidelines, which note that “Codes 99381-99397 include counseling/ anticipatory guidance/risk factor reduction interventions which are provided at the time of the initial or periodic comprehensive preventive medicine examination.”

CPT^® guidelines go on to say that, as we saw in Myth 1, the risk factor reduction codes are only appropriate for encounters “separate from the preventive medicine examination.”

Myth 3: Contraceptive Services for Medical Reasons Are Billed the Same Way as Contraceptive Services for Preventing Pregnancy.

While contraceptive services for preventing pregnancy would be billed as either a preventive medicine service exam or counseling if it is a standalone issue, if the contraceptive service is due to medical reasons, you may report it with the appropriate office visit code, experts say.

Some of the most common reasons for using contraception for medical indications include menstrual-related conditions or irregular periods (N92.1, Excessive and frequent menstruation with irregular cycle) or endometriosis (N80.-).

“Contraceptive treatment for such medical problems would be billed as a problem-oriented service,” Rasmussen says. So, if your ob-gyn prescribes contraception for medical reasons, you can no longer code the service using 99381-99385 or 99391-99395. In this situation, you will now have to choose the appropriate E/M service from 99201-99215 (Office or other outpatient visit for the evaluation and management of a new/ established patient …).

Myth 4: You Cannot Bill Injectable Contraceptives and IUDs Separately from Counseling Services.

You may be able to bill both forms of contraception separately from either a preventive counseling only, or preventive medicine visit on the same date of service based on your payer’s policy. Some will deny the insertion of an IUD with an E/M service while at the same time allowing for the injection procedure. Documentation of a separate and significant preventive service will determine final payment. So, if your ob-gyn administers Depo-Provera to your patient at the time of the annual preventive visit, you can go ahead and bill J1050 (Injection, medroxyprogesterone acetate, 1 mg) for the supply along with 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular) for the injection itself. But remember that the quantity billed for J1050 is equal to the dosage injected (e.g., 150 mg would be a quantity of 150).

And if your provider opts for insertion for one of the following intrauterine devices…

• J7297 (Levonorgestrel-releasing intrauterine contra­ceptive system (Liletta), 52 mg)
• J7298 (Levonorgestrel-releasing intrauterine contra­ceptive system (Mirena), 52 mg)
• J7301 (Levonorgestrel-releasing intrauterine contra­ceptive system (Skyla), 13.5 mg)
• J7300 (Intrauterine copper contraceptive)

… then you’ll be able to bill for the supply along with 58300 (Insertion of intrauterine device (IUD)) for the service. However, remember that you will also need to add a modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the preventive service when billing 58300 on the same date of service as it still qualifies as an E/M service.