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99401-99404 Medicaid

  1. #1
    Question 99401-99404 Medicaid
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    Our Doctors and Nurse Practitioners have begun to see patients for weight loss. The dx is usually Morbid Obesity, and they list a diet and exercise plan in the medicine section of the progress note. ( They tend to forget to mark the education sections for this)

    I am wondering what E/M to use. I think that 99401-4 codes are most appropriate, but would require them to specify time spent just as they do the smoking cessation codes. This is a rural health center, a nd claims with obesity as primary are always denied by medicaid. So I'm assuming the counseling visits are the correct way to go about this. Any thoughts are very much appreciated.


  2. #2
    Cool CPT 99401 series Nutrition Required CPT and DX Codes
    It is important to have the diagnostic code first Z71.3 for diet counseling and Z71.82 if the doctor speaks of exercise counseling. Once this is supported by documentation use the BMI dx codes (you need 2 dx codes to match E66 and Z68 weight %) according to BMI on record for day's treatment. Link all these dx codes to the CPT 99401 series. Oh yes one more thing the patient must have a BMI over 30% for insurance to pay.

    I hope this helps you.

    Lady T

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