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Family Planning

Tracey Posted Tue 11th of June, 2013 15:19:46 PM

How should I bill family planning counseling that was performed during a preventative visit?

SuperCoder Answered Thu 13th of June, 2013 06:12:29 AM

If the purpose of the visit it to prevent pregnancy, you use V25.x. If the purpose of the visit it to use family planning to get pregnant, you use a V26 code. And yes, the 99401-99404 codes are correct for either contraceptive or procreative counseling - these are preventive service, not evaluation of a problem that needs medical or surgical management. Your FCP should be billing for this directly unless your payer has indicated this person is not considered a qualified provider of care. Some payers will allow you to bill this under the physician's billing number, but not all and you should never assume this is true. The only published rules on this topic are for Medicare patients within their "incident to" rule. This rule requires that the treatment plan be set up by the billing provider before an ancillary person can render care. The rule does not apply to preventive services 1) because Medicare does not cover these types of services, and 2) preventive counseling does not normally involved setting up a treatment plan. Also you should not consider this a "consult" in the coding sense. This is a counseling session with the patient which may or may not be requested by an MD, but it is still a preventive service, not a problem E/M service or a consultation.

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