Ob-Gyn Coding Alert

Question: We have a lot of patients who self-swab for sexually transmitted infection (STI) testing, and she was counseled on all methods of contraception and elected for a prescription for birth control pills. We’ve been billing a 99211, 99000, and a 36415.

We are only being paid for the 36415 and the 99000 — literally under $10. Maybe we should bill a 99212? Do you have any suggestions?

Georgia Subscriber

Answer: The question you need to ask is: Who is seeing the patient? Code 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional) is a visit “that may not require the presence of a physician or other qualified health care professional.” It’s often used for registered nurse (RN) visits. Is the patient meeting with the RN, or with the physician/nurse practitioner? If the patient saw the provider that day and not just the RN, then you would not report 99211.

If the only other service was counseling, then you would report 99401-99404 (Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure) …) for this service.

Additionally, why are you billing 99000 (Handling and/ or conveyance of specimen for transfer from the office to a laboratory) at all? If the patient is collecting the swab, and the practice is only doing the labeling and leaving the sample for the lab to pick up, this code would not apply.

Code 99000 has no relative value units (RVUs) assigned, so if and when it is paid, it will be strictly payer-determined. In general, 99000 was developed to take account of costs to the

practice such as using your own lab equipment to prepare the sample (such as spinning it down) and then paying a lab to come get the sample (or in some cases, having office personnel take the sample to the lab). It is not intended for routine labeling of a specimen and sticking it in the lab box to be picked up.

You could bill 36415 (Collection of venous blood by venipuncture) if you are taking a blood sample to be sent to the lab. This code also has no assigned RVUs and reimbursement for this code is also quite low.