Ob-Gyn Coding Alert

Tip:  Dont use 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.

Learn how to determine which code to report and what documentation you need using these three scenarios. Study Preventive Medicine Counseling 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 session's duration, says Tara Farmer, CPC, coder/collections at Greenwood Obstetrics and Gynecology in Greenwood, S.C.:

- 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. 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, ACS-OB, OGS, clinic manager at Oklahoma University Physicians in Tulsa.

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.
 
Scenario 1: Master This Birth-Control Example If the ob-gyn spends 15 minutes discussing and prescribing birth-control pills during a preventive medicine counseling session with an adolescent patient, report 99401 and link it to V25.01 (Encounter for contraceptive management; prescription of oral contraceptives).

When the physician prescribes alternatives such as the contraceptive patch during a preventive medicine counseling session, link V25.02 (Initiation of other contraceptive measures) to the appropriate code for preventive medicine, individual counseling (99401-99404). You should note, however, that V25.02 excludes intrauterine devices (IUDs).

Remember: Because 99401-99404 are time-based, your physician must document the amount of face-to-face time spent counseling, and the content of the counseling is crucial, Farmer says. Notes for the counseling visit should include references to pamphlets or other materials the physician reviewed with the patient.

Keep in mind: If an adolescent comes in for a follow-up visit after an initial birth-control prescription, you can report a regular E/M service (99212-99215) with a birth-control diagnosis (V25.4x) because the physician is now monitoring the side effects of the drug, coding experts say. And because most of these visits will involve [...]