Wiki Obesity at Preventive Care Visit

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cbeste

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I have a provider who coded a 99213 with a 99394 because he counseled the patient on his obesity during his well-child check. My feeling was that the obesity counseling should be included as part of the 99394. However, I did some research and it seems that if the obesity were addressed with counseling and/or risk factor reduction interventions for at least 15 minutes and if the provider had documented the time spent on this counseling, then a 99401 or a 99402 could be coded with the comprehensive preventive medicine code 99394. I couldn't find anywhere that said a 99213 would be appropriate in such a scenario. Does anyone have any experience coding for obesity at a preventive care visit? I would greatly appreciate any help.
 
Obesity at Preventive Care Visits

We add G0449 Annual face to face obesity screening with DX of V65.3 as an additional charge on with the physical you must add the documentation of what was discussed and suggested for this plan. Hope this helps.
 
Obesity at Preventive Care Visits

You can't use G0449 code on a well child visit. G codes are only for Medicare. You are correct just to use the original well child code of 9939X or 9928X. Number one, insurance hate the obesity code, they only want you to use the abnormal weight gain. Plus it should be bundled into the well visit. Hope this helps.
 
Physicians disagree with this. As per Physician there is time and work involved. They want to use atleast 99212 with preventive visit

Thank you for bringing up this issue to everyone's attention. It is not me alone seeing things with confusion/frustration etc.,
 
To charge an office visit with the preventive there needs to be documentation that the patient had a complaint or concern outside the preventive, or that an abnormality was discovered. The affordable care act has stated that you cannot charge a separately reportable office visit when the principle reason for the encounter is preventive.
 
weight management

I am OB/Gyn- my doctors do "weight management" using 99401 with either v code, abn wt gain or obesity- whichever applies.........can someone please give me the rules that apply to Medicare and commercial insurances? I came from Radiation Oncology to OB/GYN so I am still learning this ........ it seems Medicare denies. PLEASE HELP ME :confused::eek:
 
Obesity screening and counseling has been recommended by the US Preventive Services Task Force with a grade B recommendation and as such is a covered service under the ACA. Most private payers will separately reimburse this service. Individual payers may vary in coverage of 99401-99404 and G0446-G0447, and G0473 but many will pay in addition to the preventive medicine service as the time required is well beyond that of the counseling included in the preventive service. (Google the insurance name and preventive services and you may find a chart of covered services.) At least 8 minutes of time must be documented to support code 99401. Code G0446 requires 15 minutes (this is not limited to Medicare as some private payers do adopt HCPCS codes into their policies).

When providing to Medicare patients be sure to read the section on this service in the preventive services chapter of the claims processing manual as documentation must support the provision of the services per the benefit schedule and include all elements of service.

Billing for this preventive service with an office visit (eg, 99213) code may result in inappropriate out of pocket expense to the patient.

Hope that helps.
 
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