Wiki Billing for time spent counseling for Morbid obesity when done during a Physical

[cwestman]

Provider documents
Morbid obesity - E66.01, (HCC), 50 minutes spent with the patient, with over 50% of that spent on discussion of morbid obesity, her attempts at weight loss, the risks and benefits of bariatric surgery. Patient would like to proceed with evaluation.
This was outside of the patients AW visit of 30 minutes
The excludes note for 99404 indicates not allowed with her Physical 99395
The 50 minutes fall short of a prolonged service code
Would it be appropriate to add an E/M for weight loss counsel consideration for Bariatric surgery during her Wellness visit?
Cheri

 

[meghanhannus]

Provider documents
Morbid obesity - E66.01, (HCC), 50 minutes spent with the patient, with over 50% of that spent on discussion of morbid obesity, her attempts at weight loss, the risks and benefits of bariatric surgery. Patient would like to proceed with evaluation.
This was outside of the patients AW visit of 30 minutes
The excludes note for 99404 indicates not allowed with her Physical 99395
The 50 minutes fall short of a prolonged service code
Would it be appropriate to add an E/M for weight loss counsel consideration for Bariatric surgery during her Wellness visit?
Cheri

Hello cwestman,

The separate office e/m service can't be billed based on time as the provider needs to document that greater than 50% of the time was spent face-to-face with the patient in counseling/coordination of care. If there is more documentation to support 2 of the 3 key components then the separate e/m can be billed.

Hope this helps~

M.Hannus, CPC, CPMA, CRC

 

[GCLindsay]

Hello cwestman,

The separate office e/m service can't be billed based on time as the provider needs to document that greater than 50% of the time was spent face-to-face with the patient in counseling/coordination of care. If there is more documentation to support 2 of the 3 key components then the separate e/m can be billed.

Hope this helps~

M.Hannus, CPC, CPMA, CRC

Hello,

We have been having a hard time getting additional follow up visits for obesity counseling paid by commercial policies. We tried mimicking the Medicare frequency but they still aren't getting paid beyond that initial consult. Do you have any advise? I have been researching this for weeks and I'm running out of resources.

 

[meghanhannus]

Hello,

We have been having a hard time getting additional follow up visits for obesity counseling paid by commercial policies. We tried mimicking the Medicare frequency but they still aren't getting paid beyond that initial consult. Do you have any advise? I have been researching this for weeks and I'm running out of resources.

Hello,
What do the commercial policies/guidelines say? Are you using the correct BMI diagnosis that meets medically necessity? Has anyone tried calling and speaking with an insurance rep to see why the claims are denying?

 

[b.cobuzzi]

Counseling and risk reduction is part of preventative services. So, counseling for morbid obesity during an annual visit is considered part of he annual visit’s counseling and risk reduction.