Primary Care Coding Alert

Diet/weight problem offers E/M service coding opportunity


 Childhood obesity is still a major health issue, and FPs are a vital part of the medical community striving to prevent the disease's spread. Our experts reveal the CPT codes you should use for this work directive.

Address These Habits

 Before you code for the AMA's newly recommended dietary childhood assessments, get up to speed on the mandates- details. All children should -receive at least an annual assessment of their weight, dietary habits and physical activity levels,- according to the article -Expert Panel Gives Very Heavy Children a New Label ��" Obese- in the July 9, 2007, issue of American Medical News published by the AMA.  The assessment should address problematic issues, such as frequent restaurant dining, drinking large amounts of sweetened beverages, and excessive screen viewing time.

 The article calls for additional labs in problem patients. If the FP diagnoses the child as overweight, staff should measure the patient's blood pressure and pulse and order lipid studies. The physician should also test obese children's liver and kidney functions.

 Should you classify these assessments as preventive medicine counseling, preventive medicine services, or sick visits? Experts walk you through the coding do's and don't of these latest recommendations. Don't Use 99401-99404 for Normal Assessment  Question: Should you account for this weight-related work by using 99401 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 15 minutes) in addition to the well checkup code?  Answer: No. This code combination is incorrect for one simple reason. -CPT categorically does not allow you to report counseling and/or risk factor reduction intervention codes at the same encounter as a preventive medicine service,- says Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare in Zanesville, Ohio. Physicians must provide 99401-99404 -at a separate encounter for the purpose of promoting health and preventing illness or injury,- says the AMA in CPT's counseling and/or risk factor reduction intervention introductory notes. The counseling and/or risk factor reduction intervention code family describes counseling in 15-minute increments.

 When an FP provides preventive medicine counseling at a preventive medicine service, you should report only the preventive medicine service (99381-99387 for new patients and 99391-99397 for established patients).

  Preventive medicine services include counseling/anticipatory guidance and risk factor reduction provided at the same encounter, according to CPT's preventive medicine services introductory notes.

 Not being able to charge 99401 with 99381-99387 or 99391-99397 probably won't hit your pocketbook. -Most plans consider 99401 a noncovered service,- says Nancy Reading RN, CPC, director of education for the American Academy of Professional Coders in Salt Lake City. -I would not bank on seeing extra revenue for this [CPT code].-

 Good news: -Some payers, such as Ohio Medicaid, may cover 99402-99404 when billed [...]