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Preventive versus EM Coding for Urology

  1. Question Preventive versus EM Coding for Urology
    Medical Coding Books
    This has been a long standing debate that I am sure several of Urology offices face. Is it routine or not, if it is can a Urologist(Specialist) bill the preventative 993-codes?

    Does anyone have experience with this?

    Darlene Nieves, CPC

  2. #2
    Kansas City, MO
    The only time our group will bill a preventive e/m code is for a Medicare pts; if the doctor only documents that he did a dre and found no abnormalities, we bill G0102. The guidelines for preventive medicine codes just don't fit what most urologist do in their scope of practice. In the rare cases where we see pts for strictly cancer screening, we bill out a lower level e/m "sick" code.
    Hope this helps
    Karen Cross, CPC, CPMA, CEMC, CUC

  3. Default
    Though it is for routine evaluation and management of a healthy and no complaint' client , these codes are intended to be used to identify COMPREHENSIVE (nature) Services-meaning- Multisystem Examination – the determinants for the extent of examination being age and the risk factors; I don't think any ‘tag' on the type of Physician attached to it! So if an Urologist agrees /willing to provide service to his established patients , WHY NOT?

    As such, though/if not a NEW Patient, the ESTABLISHED patient with the category FOR “PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE”, Why not?

    The Code series description states, “RE-EVALUATION AND MANAGEMENT OF AN INDIVIDUAL, including an age and gender appropriate History examination, counceling/anticipatory guidance / Risk Factor Reduction interventions and the ordering of lab/diagnostic procedures, Established Patients”. 99391 – 99397.
    I think and feel justified to say that this holds good for all the Physicians, irrespective of Specialty or Superspecialty.
    I hope it makes a real good sense.
    Thank you

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