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Prev Med vs consult

Eileen Posted Tue 20th of September, 2011 18:26:19 PM

39 y/o F comes into gastroenterology office to discuss family history of colon polyps in her mother. She says her PCP sent her for consult. She is asymptomatic therefore HPI does not meet any of the required elements for consult. Comprehensive exam and recommendation for colon cancer screening in 5 years.

Should this be billed as preventative medicine (99385 w/V18.51) since she has no chief complaint and no elements of the HPI are met (i.e. duration, location, severity, etc.)?

SuperCoder Answered Wed 21st of September, 2011 08:51:00 AM

To my opinion, yes. Since there's no CC and HPI, and no suspected / unsuspected Dx found out during the visit, and only a kind of councelling, comprehensive exam and recommendation for colon Ca screening in next 5 years was prescribed, it suits for coding 99385. The comprehensive exam parameter need NOT be same as comprehensive exam criteria set by E/M codes (99201-99350), as per CPT manual. These codes (99381-99387) are developed based upon age and gender of Pt., and depend upon what all exams are done on a Pt.

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