Ob-Gyn Coding Alert

When adolescents visit gynecologists for contraceptive services, you'll need to remember to link the appropriate diagnostic code to the visit and watch for counseling-only visits to ensure proper payment.

According to a recent article in the Journal of Pediatric and Adolescent Gynecology, 75 percent of sexually active teens use some form of contraception, effectively reducing adolescent pregnancy rates. Even so, Medicare and many other payers do not reimburse for contraceptive services or the provision of birth-control methods. When birth control is not covered, practices should notify adolescent patients or parents that they will be billed directly.

When birth-control counseling is part of a preventive medicine exam, report 99384 for a new patient age 12 through 17 years, and 99394 for established 12- to 17-year-old patients. Birth-control counseling is included in the wellness exam, coding experts say.

When an adolescent sees a gynecologist for a problem, such as irregular periods (626.4), and the physician spends time discussing contraception or recommends oral contraceptives to regulate irregular periods, report the appropriate office visit code (99201-99215).

Most adolescents use oral contraceptives, which have a number of benefits, including alleviating menstrual irregularities, says Kathryn Cianciolo, MA, RRA, CCS, CCS-P, an independent coding consultant with Meridian Resource Company of Waukesha, Wis.

Gynecologists typically do not recommend intrauterine devices (IUDs) for adolescents and young adults, Cianciolo adds. Likewise, adolescents may have difficulty with birth-control injections because they must return every three months for Depo-Provera injections, for instance, and may have unpleasant side effects such as weight gain and acne, she adds.

The new contraceptive patch (Ortho EvraTM) is becoming popular with adolescents, however, so gynecology practices may see an increase in requests for it, says J. Kell Williams, MD, associate professor of obstetrics and gynecology at the University of South Florida, College of Medicine in Tampa. Patients who use the patch wear it continuously for 12 weeks and go patchless for week 13, which means they have only four bleeding cycles a year, he says.

If the adolescent comes in just for initiation of birth control or for birth-control counseling and does not have a preventive medicine exam, you would report a preventive medicine counseling code, such as 99402 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 30 minutes), says Brenda Dombkowksi, CPC, a coder with the Obstetrics-Gynecology and Infertility Group in Cheshire, Conn. Some carriers will not reimburse for counseling, so it's a good idea to discuss this with the patient ahead of time, she says.

You'll stand a better chance of convincing payers to reimburse for counseling if you're able to provide particulars on the content of the discussion and reasons the physician prescribed a certain contraceptive.

Link the appropriate contraceptive management diagnosis code in the V25 range to the preventive medicine exam codes for adolescents (99384, 99394) or to the counseling codes (99401-99404) if the patient does not have a preventive medicine exam.

For instance, if the physician spends 15 minutes discussing and prescribing birth-control pills during a preventive medicine counseling session with an adolescent patient, report 99401 (Preventive medicine counseling ...; approximately 15 minutes) and link it to V25.01 (Encounter for contraceptive management; prescription of oral contraceptives).

When the physician prescribes such alternatives 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 IUDs, Cianciolo says.

Codes 99401-99404 are time-based, so documenting the amount of face-to-face time spent counseling is crucial, Cianciolo stresses. Notes for the counseling visit should also include references to pamphlets or other materials the physician reviewed with the patient, she says.

When 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 emphasize.