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Preventive Counseling 99401-99404

  1. #1
    Question Preventive Counseling 99401-99404
    Exam Training Packages

    The preventive/counseling codes 99401-99404 are timed based codes 30 to 60 minutes. How do we determine on the record which is the appropriate code to use, does the physician have to state the time spent counseling the patient? I know the type of counseling has to be recorded. I have doctors who of course are choosing the 99404 (60 minutes) for the higher reimbursement. I do not have access to CPT Assistant to get more define rules on these CPT's, anyone who can send me any info., will be greatly appreciated.....
    Marilyn CPC, CPC-H, CEMC

  2. #2
    North Carolina
    Per CPT Assistant......

    These codes are time-based codes. The appropriate code is selected based on the approximate time spent providing the service. The extent of the counseling and/or risk factor reduction intervention must be documented in the medical record to qualify the service based on time.

    I've reviewed the CPT Assistants that applies to these codes and this is about as detailed as it gets...

    Hope this helps~

  3. #3
    Thank you, I was afraid of that... AMA comes up with these codes and then they are so grey.... a time based should always require the documentation of time spent along with the counseling.... Who am I to argue with a doctor after she/he chooses the 45min code and has written down the counseling and coordinating care, if indeed they spent 45 minutes with that patient..we all know that's far fetched.....

    Marilyn CPC, CPC-H, CEMC

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