Patients Health Is Key Factor in Coding for Counseling
Published on Fri Feb 01, 2002
When doctors counsel patients on disease care or preventive health, they should be paid for their time. However, many offices are unsure how to code for counseling time. The result is a loss of significant, earned revenue.
There are two basic ways to code counseling services:
Use the 99401-99404 series of preventive medicine counseling codes.
Use the time component of an E/M visit (e.g., 99211-99215).
Differentiating Between the Two Is Easy
When the patient presents for counseling on a known problem, use the time component of an E/M visit. When the patient seeks counseling to avoid a problem, use the counseling codes, says Susan Callaway, CPC, CCSP, an independent coding and reimbursement consultant based in North Augusta, S.C.
It may sound simple, but frequently coders do not recognize the difference. Ask this key question when choosing a code: Does the patient have symptoms of, or has he or she been diagnosed with, an illness or disease that is the subject of the discussion?
Counseling Codes Have Limited Use
The counseling codes are used when the physician sees a well patient for counseling and/or risk-factor reduction. Choose the correct code based on the time spent counseling, beginning with 99401 (preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 15 minutes) and extending to 99404 ( approximately 60 minutes).
The purpose of the visit must be promoting health and/or preventing illness or injury. If the patient is ill, the counseling codes should not be used. For example, use a counseling code when the doctor provides counseling on diet and exercise for a well patient who wants to lose weight, but not when the doctor provides the same services to a diabetic.
The preventive medicine counseling codes have a fairly limited use, says Emily Hill, PA-C, president of Hill & Associates, a consulting firm in Wilmington, N.C., that works with physician practices on coding and compliance. They cannot be billed with any other service on the same day.
A physicians office, for example, cannot use 99401 with a preventive medicine office visit code, e.g., 99381-99397, because that series includes counseling time in its reimbursement schedule. The physicians office also cannot use a counseling code with an E/M code .
According to CPT, counseling codes apply when a physician counsels on family problems, diet and exercise, substance abuse, sexual practices, injury prevention, dental health, and diagnostic and laboratory test results available at the same time of the encounter.
Callaway gives an example: [...]
