Patients Without Coverage Responsible for Payment
Published on Wed Nov 05, 2008
Question: A young patient wants to meet the doctor to discuss birth control or sexually transmitted diseases (STDs) but doesn't want her exam yet. Will we have any luck reporting 99401 and being paid? Vermont Subscriber Answer: If you have problems with payment regarding 99401 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 15minutes), your issue lies with coverage, not coding. Bottom line: If the patient does not have coverage for this type of visit, she is responsible for payment. If she has coverage, but the payer will not accept 99401, you should have the payer put in writing the correct way they want you to bill this service. Don't lose this documentation. The day may come when they change their minds and come after you for incorrect coding. Note: You will not bill this service as an office visit based on time because discussions about birth control and STDs are preventive, not problem services. If the ob-gyn counsels the patient about STDs due to the presence of an infection or confirmed exposure to an STD (in other words, unprotected sex with a partner.
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