Obese/overweight patients


Chula Vista
Best answers
This comes from a provider in our practice. There is a serious difference of opinion on how to code these. Any help would be appreciated.

My question relates to coding for weight related services. Many times during a well visit we see a child who is obese. Sometimes we do brief counseling and may or may not order some screening labs. We may give some brief intervention. If the parent is interested we offer a longer appointment to go over weight, risks, family history, and review questionnaires related to weight and activity and review labs if they were ordered. Can this subsequent visit be coded as a problem oriented visit (typically 99213 or 99214) with dx of obesity and any other code (such as hypercholesterolemia or elevated liver function tests, acanthosis nigricans, hypertension or even family history of diabetes) or are these considered strictly counseling visits to be coded with 99401-99404? When they return for follow up of weight to see how they are doing, how would this be coded?
As a follow up question: since the counseling codes are not billed at the time of a preventive visit, are we able to use a problem oriented code (99211-99215) with modifier 25 during a well check if you spend significantly more time--more than just a few minutes counseling about weight, diet and exercise and order labs or is this always considered part of the anticipatory guidance of a well visit, no matter how involved the visit/counseling is?