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Thread: Documentation Guidelines for Cpt Code 99401 thru 99404

  1. #1

    Default Documentation Guidelines for Cpt Code 99401 thru 99404

    Can any one HELP with what the provider needs to document in the Chart for these particular codes. I have a Physicians Group Primary Care , Telling me that in the Assessment for Obesity they dont have to document the waist circumference as it is not stated in Medicare's Guidelines. Nor are they documenting Time or Risk Factors. Unless i am Wrong , Time is a Must , Risk Factors is a Must and I would think if medicare is requesting an Assessment be done , Waist Circumference is apart of an Assessment. Does anyone have anything in Writing ?

    Concerned for a Potential Audit.

  2. #2
    Join Date
    Apr 2007
    Longview, TX

    Default Code 99401 thru 99404

    Medicare doesn't pay for these codes at all. From the CPT guidelines, it appears that time is the only factor in determining which code, which would indicate that it should be documented, along with any counseling and lab test results. I found the following info from the AMA and it may be helpful:

    Tobi Downs, CPC, CGIC

  3. #3

    Question Preventive Coding

    I have a patient traveling out of the Country, using codes 99401-99404 - what does my doctor need to document?? Is it the same as E/M coding?? >50% counseling patient ?

  4. #4
    Join Date
    Apr 2007


    Good question. We've consulted two auditors and both said time is definitely required but beyond that "it depends". Have you looked at US Preventive Services Task Force Screening for Management of Obesity in Adults? http://www.uspreventiveservicestaskf...f/uspsobes.htm
    Also look at USPSTF Behavioral Counseling in Primary Care to Promote a Healthy Diet. It goes into more detail about counseling. Maybe you can pull some bullet points out of it. http://www.uspreventiveservicestaskf...iet/dietrr.htm (this one is in process of updating so watch for changes)
    It all seems rather vague to me. Auditors advised us to check with each payer for coverage guidance and of course they're all over the place. When we bill plans that are PPACA we try to comply with each payer's interpretation of the Task Force recommendations.

  5. #5
    Join Date
    Apr 2007


    There's an article on Preventive Counseling in the September 2011 Coding Edge.

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