Ob-Gyn Coding Alert

Question: One of our providers wants to bill a preventive counseling code (99402) with 627.2. She also stated in her notes that she and the patient had a language barrier. Therefore, the visit took a lot longer to explain things. She noted her time to be 35 minutes extra. Can I base time on this obstacle? If so, how should I report this?

Ohio Subscriber

Answer: First, if the patient is having menopausal symptoms -- which is the only time you can use 627.2 (Symptomatic menopausal or female climacteric states) -- the visit would not be preventive (99401-99404, Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual) but a problem visit (99201-99215, Office or other outpatient visit ...).

If the typical time for the problem E/M is exceeded by 30 minutes, you can consider adding prolonged physician services code(s), but make sure you have read the guidelines in CPT carefully before reporting these codes. In general, if the problem visit was dominated by counseling, and the total time for the visit was 40-70 minutes in length, you would report 99215. Your ob-gyn must document this counseling time correctly as the percentage of total time. Simply indicating a visit that was 35 minutes longer than usual will not be helpful in supporting a problem E/M service by counseling time rather than the key components.

You would report a preventive counseling service only if the patient is currently not having symptoms, but wishes to discuss options if she starts having them. In that case, the diagnosis would be V49.81 (Asymptomatic postmenopausal status [age-related] [natural]). You would select each code based on the total time spent counseling the patient irrespective of the reason it took longer. Your ob-gyn must document this in the chart. You have multiple options for 9940x codes based on time, going from 15 minutes up to an hour of total time.

ICD-10: When ICD-9 becomes ICD-10 in 2013, you'll report the following equivalents:

627.2 = N95.1 (Menopausal and female climacteric states)

V49.81= Z78.0 (Asymptomatic menopausal state).

-- The answers for You Be the Coder and Reader Questions provided by Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M.