Wiki Contraceptive management e/m

[brookequerry]

Would it be appropriate to bill 99391-7 for contraceptive management visits since it is a preventive service even though we didn't provide enough service to be considered a preventive visit (like if we were missing the comprehensive history)? Or would it be appropriate to code 99211-5? I have read that ppaca services are covered without cost share, and the e/m if for the sole purpose of delivering these ppaca services will also be covered at no cost share. My coding team is discussing how we are coding these when a patient is seen for depo injections and requires an e/m for prescription, injection, and pregnancy test. Can anyone provide clarification?

 

[jonique.dietzen]

I have always consider contraceptive management visits to be "problem visits". There is a specific reason (chief complaint) for the visit. The visit is for medication management that requires an E/M.

99391-7 doesn't really fit because the patient is being seen for a specific reason. "Preventive medicine services are provided to individuals who are not in need of any immediate medical attention... These visits are different from other visits where the patient has a problem for which medical attention is sought." If the patient is being seen for their annual well woman exam or routine physical exam and the provider also updates their contraceptive prescription, then I would use the preventive codes.

Jonique Dietzen, CPC, Project Manager