99401-99404

donna.beaulieu@emoryhealthcare.org

Good afternoon-

Has anyone on the list billed these codes yet? If so, what was the payer response? Of course there was confusion among the physicians as to what these codes were (mixing them up with a physical), so we have not started using them yet. Appreciate any feedback, and wishing all a great weekend.

Donna

Donna M. Beaulieu, CRC, C-CDIS, CPC-I, CPMA, CPC, CEMC, CIMC, CEDC, CFPC, CCP-P, CRP
Certified Green Belt Lean Six Sigma
Assistant Director, Patient Financial Services

[Emory Healthcare]

Erica

Yes I’ve been billing preventive counseling for years. I find that most commercial plans cover this. Medicare/MA plans do not and MassHealth (Medicaid) does not.

donna.beaulieu@emoryhealthcare.org

Thanks Erica. What types of ICD codes do you typically using ? There are only so many risk-associated codes.

Thanks for your feedback,

Donna

Erica

Most often it is Z71.89 - other specified counseling. This is used in our travel clinic mainly. Patients traveling overseas are counseled on how to avoid travel associated diarrhea and other infectious diseases. Sometimes the OB/GYN office uses these codes for contraceptive/family planning counseling.

Patients being counseling regarding an active problem/condition would get billed as an E&M service based on time.

99401-99404 are strictly for PREVENTIVE counseling and the dx should be a z-code.

Thanks,
Erica

mbb@preventive-med.net

We also use them... often for weight related issues. Then can be used with an e/m, for instance pt comes in for diabetes monintoring (9921x) and physician discusses weight management so maybe BMI is 32. We add the E66.09 for non morbid obesity and bill 99401. Will need mod 25 on the office call. But they will need to document the time spent, in this case >8 minutes for 99401 and the nature of counseling.

Some visits are JUST the preventive counseling. It falls under the 100% payment category in healthcare reform so if it accurately reflects the visit nice benefit for the patient.

Dawn Breithaupt, CPC
Preventive Medicine

janrpcs@aol.com

I would have to say the below is an inappropriate use of the 9940x codes. These are for counseling to prevent a problem. Overweight is considered a disease and therefore it should be reported as "disease" counseling especially when associated with another related condition with the appropriate EM codes based on time not the 9940x codes.

donna.beaulieu@emoryhealthcare.org

Thanks Dawn. I was wondering if a problem-related diagnosis/es were being used versus screening. Appreciate the feedback!

Donna

donna.beaulieu@emoryhealthcare.org

Thanks Erica. I am getting "mixed" answers. I understand your viewpoint. Appreciate your feedback.

Donna