Annual Physical Exam & renewal of birth control

[Michael0630]

I have a question,

My OB providers see a lot of patients for Physical exams and then they will also renew patients birth control as well. My question is is it appropriate to bill 9938-9939 with also an e/m with diagnosis Z30.41?

I thank you in advance.

 

[csperoni]

I have a question,

My OB providers see a lot of patients for Physical exams and then they will also renew patients birth control as well. My question is is it appropriate to bill 9938-9939 with also an e/m with diagnosis Z30.41?

I thank you in advance.

In most situations, renewing OCP during an annual preventive visit will not be sufficient to bill both a preventive and a problem oriented E&M. In order to do so, -25 is needed on 99202-99215. If you were to take the documentation and cross out everything related to the preventive well woman exam, is what you have left "significant"? For straightforward renewals, I would not imagine so. Perhaps if the patient were having issues - breakthrough bleeding, heavier menses, etc. and the provider documented and discussed this and perhaps changed the medication, you MIGHT have a 99202-99215 with -25 modifier.

 

[mmckibbin]

Birth control management is not part of her annual preventative visit. You can definitely bill a e/m level with the physical code as long as you have the modifier -25 with it. See if the doctor will give you time as well, if they specify that the time for the birth control management was not included in the physical time, that might help you know which level to use also.

 

[Cynthia Hughes]

See coding advice from ACOG here, https://www.acog.org/education-and-events/publications/larc-quick-coding-guide/em-services-code-only. This is specific to long-acting reversible contraceptive but the same would apply to prescription of other forms of contraception.

Hope that helps,
Cindy

 

[nielynco]

Birth control management is not part of her annual preventative visit. You can definitely bill a e/m level with the physical code as long as you have the modifier -25 with it. See if the doctor will give you time as well, if they specify that the time for the birth control management was not included in the physical time, that might help you know which level to use also.

Both I and ACOG will have to disagree. Birth control discussions are certainly included as an integral part of a preventive medicine service when indicated. Only if the patient presents with significant problems that had to be evaluated because of the use of birth control would a problem service be warranted at the time of the preventive visit. And as many on the forum have carefully pointed out - take away all of elements that are related to the preventive service to see it you still have anything significant to bill that would warrant reporting the service (with, as you have indicated, a modifier -25 added to the significant problem service).

 

[atheri992]

I agree the conversational piece is included in a preventive service (we discuss all the options but they don't decide on anything at the time of the encounter), but what about initiation of oral contraception? The physician is taking on the risk of prescribing even if for a symptomatic concern or birth control? If they came for a separate visit, it would be enough to support an E&M with Z30.011- Encounter for initiation of contraceptive pills. Any thoughts?

 

[nielynco]

I agree the conversational piece is included in a preventive service (we discuss all the options but they don't decide on anything at the time of the encounter), but what about initiation of oral contraception? The physician is taking on the risk of prescribing even if for a symptomatic concern or birth control? If they came for a separate visit, it would be enough to support an E&M with Z30.011- Encounter for initiation of contraceptive pills. Any thoughts?

It is not the risk to the provider, but the risk to the patient for the decision that is measured. Most physicians will give the patient the choice of BC options with pros and cons (that is part of the discussion so part of the preventive service). Then she decides which one to go with and he/she writes the prescription. At what level of medical decision making do you think this represents? Minimal to low will be the best you can do for the average patient with no previous history or health issues that might impact being on BC. If all you can bill is a 99212 can you honestly say that meets the definition of significant work? The payer will of course make the final decision, but also consider that the patient will probably also now owe a copay when she came is for a co-pay exempt service.