You Be the Coder:
Hormone Refills
Published on Wed May 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: A menopausal patient is scheduled for her annual exam, but all she really wants is a refill on her hormones. Her carrier will not cover preventive care, only problem-oriented. How should I code her visit?
Maine Subscriber
Answer: Although this may be an ongoing problem for the patient, this is still a preventive service and should be coded as such, unless your physician has not performed the Pap smear, breast check, and the rest of a comprehensive exam and history appropriate for the patient's age. Menopause is a natural process of aging, not a disease condition, and the medication she is prescribed is to prevent complications in the future. Remember that you are not responsible for your patient's health coverage policy; you are only responsible for seeing that she receives quality care. You should educate the patient, explaining what a preventive service consists of and why it is important to her health.
If she elects not to have a preventive service performed, you should bill only for the service she requested, and that will be a low level of E/M service (99212-99213) for script renewal. There would be no need to perform a comprehensive exam and history solely for monitoring hormones (especially if the patient stated there were problems) and medical decision-making likely will be of low complexity.
