Question Woman's Wellness guidelines

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Hello all,
We all know how hard E&M coding can be so I want to clarify what we can or cannot bill. I work in a public health clinic where we see women for their yearly woman's wellness exam. According to our nurses, we have patients who come in for their yearly physical exam. During this exam, they discover the patient is sexually active but not on any type of birth control. The nurse then counsels the patient on the many different options she has for birth control. The patient decides to go with an implant, which the nurse inserts during the same visit.
Am I allowed to bill for all 3 services? The E&M office visit, the counseling, AND the implant insertion (99214 w/ mod 25, 99401, and 58300)?? Please help!
 

kathrynw

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Hello,
I did not find any NCCI edits for the codes provided, but the following articles from CPT Assistant might be helpful.
March 2016; Volume 26: Issue 3
Coding Update: Counseling Risk Factor Reduction and Behavior Change Intervention Changes in 2016

Coding for Counseling (January 1998). CPT® Assistant.

Which mentions that specific codes are available for preventative medicine counseling services, 99401-99412. They should address problems like family, diet, exercise, substance abuse, sexual practice, injury prevention, dental hygiene, and diagnostic/laboratory test results. All of these codes are time-based codes. Select the appropriate code based on the best estimated time spent providing the service. The extent to which the counseling and risk factor reduction education needs documented in the providers report to qualify the service based on time. Services of this nature that are provided at the same time of the initial or other periodic preventative medical examinations are included in the preventative E/M service and cannot be separately reported.

Hopefully this is helpful,


 
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