Primary Care Coding Alert

Time to find out the depth of your contraceptive coding knowledge.

Once you’ve answered the quiz questions on page 3, compare your answers with the ones provided below:

Answer 1: Typically, “contraceptive discussion without a procedure is performed during a preventive medicine service exam,” says Sherika Charles, CDIP, CCS, CPC, CPMA, compliance analyst with UT Southwestern Medical Center in Dallas. Depending on the age of your patient, this means you would report 99384/99394 (Initial/Periodic comprehensive preventive medicine evaluation/reevaluation and management of an individual …; adolescent (age 12 through 17 years), 99385/99395 (… 18-39 years), or 99386/99396 (… 40-64 years).

However, “if it is a standalone service, the counseling should be reported under the risk factor reduction codes,” Charles advises. So, if a patient requests counseling prior to receiving contraceptive services, and “if your provider only performs counseling with development of a contraceptive plan, the coding would be 99401-99404 [Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual …],” says Jan Rasmussen, PCS, CPC, ACS-GI, ACS-OB, owner/consultant of Professional Coding Solutions in Holcombe, Wisconsin.

The exact code would be “based on time spent face-to-face. But many insurances may not cover 99401-99404 preventive counseling,” so it is important that you check with your payer beforehand, Rasmussen cautions.

As for billing 99381-99397 and 99401-99404 together, the answer is a hard “no.” CPT® guidelines note that “Codes 99381-99397 include counseling/anticipatory guidance/risk factor reduction interventions which are provided at the time of the initial or periodic comprehensive preventive medicine examination.” Similarly, the descriptors for 99401-99404 also contain the words “counseling” and “risk factor reduction interventions,” meaning that both the counseling and the development of a contraceptive plan would be included in both services.

Answer 2: “Contraceptive treatment for a medical problem would be billed as a problem-oriented service,” says Rasmussen. So, for patients suffering from conditions such as endometriosis (N80.-) or excessive, frequent, or irregular menstruation (N92.1), — which can be treated with IUDs such as J7298 (Levonorgestrel-releasing intrauterine contraceptive system (Mirena), 52 mg) or J7301 (Levonorgestrel-releasing intrauterine contraceptive system (Skyla), 13.5 mg), or a contraceptive injection such as Depo-Provera (J1050 [Injection, medroxyprogesterone acetate, 1 mg]) — you would choose the appropriate E/M service from 99201-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …).

Answer 3: The answer here is “yes.” You can bill both the supply of injectable contraceptives such as Depo-Provera along with 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular) for the injection itself.

The same is true for IUDs and contraceptive capsules — you can not only bill for the supply, but you can also bill for the insertion services using 58300 (Insertion of intrauterine device (IUD)) or 11981 (Insertion, non-biodegradable drug delivery implant) as appropriate.