Primary Care Coding Alert

Question: Our physicians have our patients come back to our office after three months of putting them on birth control to make sure everything is fine. Most patients are on birth control for contraception. I have been using V25.01 or V25.41, but our payers have been denying the claims. What procedure and diagnosiscodes should I use?

Minnesota Subscriber

Answer: If your physician is still doing preventive medicine counseling, use 99401-99404 (Preventive medicine counseling ...). Otherwise, you can only report the problem E/M codes (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ...) for these followup visits. CPT does not offer many good codes for less than comprehensive preventive care visits.

Best advice: You need to ask your payers if they do, in fact, cover the follow-up visits and if so, how they want you to bill them, since they deny your claim when you use the V codes (V25.01, Encounter for contraceptive management; General counseling and advice; Prescription of oral contraceptives, and V25.41, Surveillance of previously prescribed contraceptive methods; Contraceptive pill) appropriately.

ICD-10: When your diagnosis system changes in 2013, you'll report the following equivalents:

• V25.01 = Z3Ø.Ø11 (Encounter for initial prescription of contraceptive pills)
• V25.41 = Z3Ø.41 (Encounter for surveillance of contraceptive pills).