Ob-Gyn Coding Alert

Question: Our providers have our patients come back to our ob-gyn office after three months of putting them on birth control to make sure everything is fine. Most patients are on birth control for contraception. I have been using V25.01 or V25.41, but our payers have been denying the claims. What procedure and dx code should I use?

Answer: If your provider is still doing preventive counseling, use 99401-99404 (Preventive medicine counseling ...). Otherwise, you can only report the problem E/M codes (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ...) for these follow-up visits. CPT does not offer many good codes for lesser preventive care visits.

Best advice: You need to ask you payers if they do in fact cover the follow-up visits and if so, how they want you to bill them since they deny your claim when you use the V codes (V25.01, General counseling on prescription of oral contraceptives and V25.41, Surveillance of previously prescribed contraceptive methods) appropriately.

ICD-10: When your diagnosis system changes in 2013, you'll report the following equivalents:

• V25.01 = Z3Ø.Ø11 (Encounter for initial prescription of contraceptive pills)
• V25.41 = Z3Ø.41 (Encounter for surveillance of contraceptive pills).