Pediatric Coding Alert
Take This Advice for Documenting Different Counseling Services Together
Question: Is it possible to report preventive medicine counseling and a preventive medicine service on the same date of service (DOS)? New York Subscriber Answer: Technically, there are no CPT® restrictions or National Correct Coding Initiative (NCCI) procedure-to-procedure edits on the codes prohibiting you from coding 99401 (Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes), 99402 (... approximately 30 minutes), 99403 (... approximately 45 minutes), or 99404 (... approximately 60 minutes) with an age-appropriate preventive medicine service coded from 99381-99397 (Initial/periodic comprehensive preventive medicine evaluation/reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/ diagnostic procedures, new/established patient …). However, because there are no restrictions on coding both services together doesn’t mean it’s a good idea for you to do so. Guidelines for 99401-99404 tell you that these services “should address such issues as family problems, diet and exercise, substance use, sexual practices, injury prevention, dental health, and diagnostic and laboratory test results available at the time of the encounter.” Distinguishing these counseling topics from the “counseling/anticipatory guidance/risk factor reduction interventions” provided as part of 99381-99397 services on the same DOS would be next to impossible. So, reporting both services together on the same DOS and getting paid for both is a documentation challenge that is probably not worth attempting. This is why the 99381-99397 code guidelines state you should “refer to 99401, 99402, 99403, [and] 99404 … for reporting those counseling/anticipatory guidance/risk factor reduction interventions that are provided at an encounter separate from the preventive medicine examination” (emphasis added).
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