Ob-Gyn Coding Alert

Question: A patient came in for her annual exam and spent additional time with the physician asking questions. The ob-gyn documented the time he spent with her. Should I code this as preventive care with a confirmatory consult or preventive care with prolonged services? New York Subscriber Answer: Neither. The preventive care codes (99381-99397) include counseling and do not allow you to take credit for time spent counseling as a separate service. You can use the prolonged service codes (99354-99357) only in addition to one of the E/M codes that has a time component (for example, 99201-99215).

The confirmatory consult codes (99271-99275) do not have a time component either. You should use these codes when the patient is coming in for a second opinion for a problem that another physician has already made a recommendation about or when the payer requires a second opinion prior to surgery. If the patient's counseling concerned actual problems that the physician was treating, you could possibly report the preventive care code and a problem E/M code. In this case, you should append the problem E/M with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to show that it was significant and separate. On the other hand, if the counseling concerned keeping the patient well, birth control, taking hormones, etc., the counseling is preventive in nature and included in the preventive medicine codes.