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Counseling Coding help

  1. #1
    Default Counseling Coding help
    Medical Coding Books
    I am coding for counseling 99402 when the physician spends time with patient about weight management/diabetes, etc. with E/M code and modifier 25, but Medicare is denying these claims.

    Can someone tell me what am I doing wrong?

    Thanks for you help.

    Rozmin Bapat, CCS-P, CPC

  2. Default
    I am understanding that you are billing and E/M code with a mod. 25 plus a 99402 (E/M code for counseling). If so, this would be billing for 2 E/M codes. If the physician is counseling during a visit and documents that 51% of his time or more is spent counseling than the level would be increased. Only one E/M code would be used.

    This is what I have understood from coding workshops I have attended.

    Sandra Marion, CPC

  3. #3
    Default
    Are you using V-Codes in your dx's?

  4. #4
    Location
    Columbia, MO
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    12,843
    Default
    Quote Originally Posted by Oceanlivin View Post
    Are you using V-Codes in your dx's?
    Why would a V code matter? Most V codes are fine as first-list dx codes some are first only allowed. This is as stated above two E&Ms being billed for the same encounter which you cannot do except for preventive and an OV on the same day.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    Maybe I have misunderstood the question Deb.
    V65.3 is the encounter code for dietary surveillance and counseling for diabetics.
    Is that not what she is stating the physician is doing?

    Also she will need to code the BMI if known as well, another "V" code.

    I suspect that then Medicare is going to require one of thier hcpcs specific codes, which, are in most cases not payable with E&M.

    Let me know what I am missing.

  6. #6
    Location
    Columbia, MO
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    hmmm maybe we are in fact reading this in two different ways. I looked back it really is not clear. I took it as a physician encounter that also included counseling for diet etc. You are seeing it as a counseling encounter for these reasons. Yes that is different. So the reason for the encounter is really going to paint the picture as far as what codes to use for the ICD-9 as well as the CPT.

    Debra A. Mitchell, MSPH, CPC-H

  7. Default
    So...when I receive an encounter form with both 99213 (for example) and 99401 circled, I should ask to see the chart to determine whether to bill a 99214 or keep it at 99213--?

    We see both codes circled often with a practice that we bill for.

    ~Kelli S.

  8. Smile
    99213 -25 can be billed in conjunction with 99401.
    The question is if the insurance will reimburse for both in your state.
    You also mentioned up coding to 99214...make sure the documentation is appropriate
    As we know many docs struggle in supporting documentation to bill for the 99214.
    I hope this helped!!
    Good Luck

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