Wiki NICU consultations based on time

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samanthad86

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I had a question about my NICU providers billing consult codes on mom that OB requests. These are primarily time-based visits counseling on high-risk pregnancies and what to expect at the time of delivery. They are documenting the HPI, indicating review of labs and/or ultrasounds then counseling on what to expect at time of delivery. They are not documenting an examination and I was wondering if the exam component is needed to bill out the consult code? Or should this be counseling codes 99401-99404 for risk-factor reduction?

-Sam
 
samanthad86 said:
They are not documenting an examination and I was wondering if the exam component is needed to bill out the consult code? Or should this be counseling codes 99401-99404 for risk-factor reduction?
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The consult codes can be billed based on time as long as time is documented correctly. If the time is not documented correctly, an exam would be required to meet the minimum criteria for a consult (3/3 key components). Regardless, if the providers are performing an exam, it should be documented.

With respect to the Risk Factor Reduction code set, CPT says: "These codes are used to report services provided face-to-face by a physician or other qualified health care professional for the purpose of promoting health and preventing illness or injury ... Risk factor reduction services are used for persons without a specific illness for which the counseling might otherwise be used as part of treatment." (emphasis mine)

The Risk Factor Reduction code set of 99401-4 does not feel applicable to me, but that would depend on the circumstances and documentation. It sounds like these are codes that should be used when the counseling may lead the patient to make a change that would reduce her exposure to a risk. If these are high-risk pregnancies because the mom is engaging in risky behaviors/exposures, maybe this code set would be applicable. If these are high-risk pregnancies because of risks that cannot be avoided or reduced, normal consult or new patient codes may be a better fit.
 
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