Reimbursement Advisor

Counseling patients on contraceptive options


<huc>Q</huc> How do I bill for patient counseling on contraception when no exam was performed? An insurance carrier has denied the code 99211 with V25.49.

<huc>A</huc> The diagnostic code V25.49 implies the patient already has been placed on a contraceptive other than birth control pills (an IUD or implantable device). If you are counseling a patient prior to initiating contraceptives, use a code from the V25.0 category (general counseling and advice).

Further, the code 99211 describes a minimal E/M service. If the physician or a nonphysician practitioner saw the patient and took a history before determining her options, this level of service would be incorrect. In fact, contraceptive counseling is actually a “preventive” service. Therefore, the preventive medicine counseling codes (99401 to 99404) are more appropriate. Bear in mind that to use these codes, you must know the length of time you spent counseling the patient. For instance, the documentation for code 99401 (preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 15 minutes) should include the content of the counseling session and the time spent. However, some payers do not cover contraceptive management, making the patient responsible for the bill. When in doubt, check with your individual payer.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

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