Primary Care Coding Alert
Time-Based Billing Is Key to Counseling Coding
Question: During the annual physical of a 19-year-old established patient, the family physician diagnoses him with bronchitis caused by smoking. In addition to the preventive medicine service, the physician documents a separate 15-minute service to diagnose the bronchitis and an additional 40 minutes counseling the patient on how to quit smoking. Should I report 99395, 99213 and 99402? New York Subscriber Answer: No, you should report 99395 (Periodic comprehensive preventive medicine re-evaluation and management of an individual ... 18-39 years) and 99215-25 (Office or other outpatient visit for the evaluation and management of an established patient ...; significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). To capture your encounter's counseling time, you should instead include the 40 counseling minutes in the office visit service. Because counseling dominates the problem-related portion of the visit, you qualify for time-based billing. If you add the 15 face-to-face diagnosis minutes to the 40 counseling minutes, you get 55 reportable minutes. Because this exceeds the 40 minutes that CPT indicates 99215 (Office or other outpatient visit for the evaluation and management of an established patient ... physicians typically spend 40 minutes face-to-face with the patient and/or family) typically contains, you should report 99215 for the time the FPspent on this case. You should also append modifier -25 to the office visit code. This indicates that the office visit is a significant, separately identifiable service from the preventive medicine service. Make sure to link the routine examination (V70.0, Routine general medical examination at a healthcare facility) with 99395, and link the illness diagnosis (491.0, Simple chronic bronchitis) to 99215-25.
Because the patient has an established illness, you shouldn't use 99402 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 30 minutes). When your FPprovides counseling at a separate visit for a patient who doesn't have any symptoms or an illness, you may submit 99402 for counseling and/or risk factor reduction intervention.
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