Ob-Gyn Coding Alert

Question: We have a patient that came in for an annual exam, and our provider spent an additional 30-40 minutes with the patient discussing other things than her annual. Can we bill for that? Would we just append a modifier? Or should I include it in her annual exam?

South Carolina Subscriber

Answers: This depends on what topics the patient and the ob-gyn discussed. If they had to do with topics on staying healthy, birth control, use of hormones, etc., you should include this in the annual visit code (99384-99386 for new patients, or 99394-99396 for established patients).  

To bill for the discussion in addition to the annual visit code, your ob-gyn must have documented the discussion with the patient. This should include what problems she has, and it must be clear this is separate from routine annual care. Then, you follow CPT coding rules and code a problem E/M service (99211-99215, Office or other outpatient visit ...) with a modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) in addition to the preventive service.

Some payers will pay for both (and of course, the patient will owe a copay for the problem service which she is not going to be happy about) and some will bundle it.