Wiki Contraception Visit

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broncsrox

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There is discussion in our office about the appropriate way to bill the visit code for the following scenario. Please take a moment to read it and give feed back including your reasoning.

25 year old patient comes to the GYN for contraception options. Doc spends 10-15 minutes discussing her multiple options (pills vs condoms vs IUD vs implant etc). In the end the patient opts for pills.

What is the correct code for the visit charge?

Thanks much!
 
I have had the same debate multiple times in my office, should it be E&M vs. Preventative Medicine Counseling?

In my opinion it would be considered Preventative Medicine Counseling and I would use the 99401 code. Sometimes, however it does depend on the payer.

In the CPT book "Preventative medicine counseling and risk factor reduction interventions will vary with age and 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."

According to page 5 in the link below that was taken from the Cigna.com website, they do include FDA-approved methods of contraception for women with reproductive capacity (a 25yo would def. fall under that category) in the 99401 code.

http://www.cigna.com/assets/docs/he...s/807467_d_PreventiveHealthCovGuide_v8_HR.pdf

Also, this link from SuperCoder.com has a similiar example to yours and they chose the 99401 code as well.

https://www.supercoder.com/coding-n...-counseling-code-every-time-heres-how-article

I would double check with your payer, but in this case I would go with the Preventative Medicine Counseling Codes.

Thanks for bringing this situation up, it helped cement my decision in when to use this code as well.

Hope this helped!
Amanda Kane, CPC, COBGC
 
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