Wiki Gyn Preventive visit and separate e&m for sterilization

[Sueforman]

I have been seeing separate e&m visits where the doctor is billing for the request for sterilization, saying this is separate from preventive care because it is a procedure, providing the risks of procedure, providing consent etc. sometimes they are documenting the extra time from the preventive. Is there any documentation that can be provided that may address this situation difinitively that would say sterilization requests/counseling is separate from contraception? I think it would be included but would like to find a policy that I could share this information with the provider and most policies just reference contraception not necessarily sterilization counseling.

 

[csperoni]

A preventive visit that also documents a recommendation/discussion of a surgical procedure, I would consider an additional separately billable E&M service.
Now, a note that says "discussed contraception methods including OCP, IUD, and tubal ligation." without real documentation about a surgery I would include with the preventive care. In order for -25 to be considered, you must have SIGNIFICANT and SEPARATELY identifiable services. If the clinician is not documenting the separate time, but is documenting the separate discussion and risks, I would level the MDM of the separate discussion.
I could not locate a reference that says "yes, a surgical discussion is billable as a separate E&M". However, there are plenty of references for modifier -25 in general. ACOG provides this as a description of the work included in a well-woman preventive visit. The word sterilization does not appear anywhere in the article.