Ob-Gyn Coding Alert

Question: Our physician sees several Medicare patients with mental disabilities. They live in an assisted-living facility, and many are established patients. The facility sends these patients to our office for their annual gynecological exams and Pap smear collection. The doctor also fills out a report. Can we bill for a consultation for these services? Can we get paid for filling out the report? Should we bill the E/M service with modifier -32?

Maryland Subscriber

Answer: You should not consider this service a consultation because these patients have no problems about which your ob-gyn can consult. No other practitioner has requested your physician's expertise to consult on a specific problem, so there is no real difference between the situation you describe and an ordinary annual gynecological exam. Also, your ob-gyn is not creating and sending a letter back to an originating physician regarding the patient's condition.
 
As for modifier -32 (Mandated services), you should use it only when coding for a confirmatory consult (99271-99275). But use these codes only when the patient or a third party (such as a payer) requests a second opinion.
 
Patients and payers often ask physicians to sign forms attesting to a patient's good health or how she can continue to work without restriction, etc. And most doctors include this as part of the annual exam and do not charge separately for it. If you must charge, you have two coding options. But to use them, you must meet the criteria.
 
First, you can use 99080 (Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form). Another option is 99420 (Administration and interpretation of health risk assessment instrument [e.g., health hazard appraisal]). If you do not qualify for these, then you should include the time spent filling out the form in the established patient E/M visit.

 - The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va.