Please help! E/M Counseling Codes

Wentzville, MO
Best answers
I recently started working in a public health office. We are conducting an audit and I have been asked to confirm the following:
The new patient is a 21 year old female seen for a general adult exam and contraceptive management. Total face to face was 50 and >50 minutes was spent on counseling. This was originally coded as a 99385 but I am being asked if we can ALSO bill code 99402. My experience is more in surgical coding rather than E/M and could use some assistance. I see that code 99385 includes counseling, but does not specify a time limit, which is where my doubt/confusion comes in. Please help and thank you in advance!


True Blue
Worcester, MA
Best answers
Routine physicals are not time specific. The age appropriate counseling would be inclusive in the 99385. 99402 is more for preventive counseling in same visit as a sick visit. It would be double dipping.

CPT manual states the following

Codes 99381-99397 include counseling/anticipatory guidance/risk factor reduction interventions which are provided at the time of the initial or periodic comprehensive preventive medicine examination. (Refer to codes 99401-99412 for reporting those counseling/anticipatory guidance/risk factor reduction interventions that are provided at an encounter separate from the preventive medicine examination.)