Wiki Contraception Discussion

[SUEV]

If a patient comes in to discuss starting contraception and has no other complaints, per CPT guidelines this would be considered preventive so directs us to the 994xx codes. I have been told that if an exam is done at that visit though, it would then be billed using the 992xx (problem) E/M codes instead. Does anyone have any references in regards to this? I'm not understanding why just doing an exam would change this from a preventive service to a "problem service". The patient still doesn't have a complaint/illness to manage so I still consider this a preventive visit. I'd appreciate any feedback you may have.
Thank you,
Sue

 

[Sue Ellen Mott]

Did you consider codes 99384 (ages 12-17) or 99385 (ages 18-39) for New Patients - Initial comprehensive preventive medicine, or Established Patient codes 99394/99395 for Periodic comprehensive preventive medicine? This is a comprehensive service and the guidelines and code descriptions are on pages 35 and 36 of the 2015 CPT. Codes 99401-99412 would only be used if the counseling, etc., is provided at a separate encounter from the preventive exam, per the guideline top of page 36.

You may want to see what the insurance carrier expects for Well Woman exams.

I hope this helps.
SEM

 

[SUEV]

Missing elements

Thanks SEM. I did consider the comprehensive preventive medicine codes but did not feel the criteria for the comprehensive "age and gender appropriate history" exam was met since there wasn't a review of systems done. The history was limited to GYN. There was a comprehensive exam though (without a GYN exam) which is why this is such a frustrating note to code. The plan is all about starting a contraceptive and doesn't address any other preventive services either.