Wiki Preventative visits for osteoporosis

[jeskla]

Hi Everyone,
Our DO says we should be coding his initial osteoporosis clinic visits with preventative medicine (9938X, 9939X) codes, but he doesn't do an examination. He does a comprehensive history, heavy on the medical decision making, and spends the majority of time counseling the patient. I have been coding by time since he spends more than half of the FTF time counseling/coordination of care. (I make sure he documents the total FTF time and what he counseled on.)

Could I have your guidance on this please? I've already showed him the CPT book description that states " Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender [U]appropriate[/U] history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures. "

He says he doesn't feel the exam is appropriate and the above states appropriate... so its not required since he has deemed it inappropriate.

 

[Orthocoderpgu]

I'm going to say that depends. Does the patient actually have osteoporosis or osteopenia? If so, then reporting these codes would not be appropriate. If the patient has no medical complaint, and the physician is helping the patient to avoid osteoporosis, that could be another matter. However, these codes were designed for the patient to have a routine exam without any medical complaint. Meaning the doc could and should find a medial issue the patient may not be aware of, not just osteoporosis. Read the heading of the section, these codes are used for basically routine exams.

The scope of the exam is determined by the physician depending on the age of the patient and their health. But the doc needs to be paying attention to all possible medical conditions, not just one. And they might be.

If the patient has osteoporosis or penia, I would use regular office visits and use counseling to determine the E/M level.