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Preventive medicine

Melissa Posted Thu 23rd of May, 2013 13:35:29 PM

Preventive Medicine codes 99401-99404. We seen a pt yesterday for latent tb ~795.51~. The doctor didnt do a physical exam but spent an hour counseling the pt. are the above code appropriate and then I need a Vcode for the DX. We dont usually do prevenitive services, however this pt is moving in two weeks and ask for counseling only. Can someone please give some guidance. Thank you

SuperCoder Answered Tue 28th of May, 2013 19:14:37 PM

This doesn't sound like preventive medicine, since there was a problem addressed at the visit (the latent TB). You can code based on time, as long as you document the total time spent and the time spent counseling the patient. You'll select the appropriate problem-based code (99201-99215).

Melissa Posted Wed 29th of May, 2013 16:50:36 PM

I didnt think it was as well, but thats what the physcian thought it would go under, and I have never had this issue before. so a physcial exam doesnt have to be done? I thought a Physcial exam always had to be done.
can you show me where the guideline is?
Thanks

SuperCoder Answered Wed 29th of May, 2013 23:59:12 PM

No, you don't have to perform an exam to bill based on time. CPT states, “When counseling and/or coordination of care dominates (more than 50%) the physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting or floor/unit time in the hospital or nursing facility), then time may be considered the key or controlling factor to qualify for a particular level of E/M services.” This means that time alone can be used to select a level of care, regardless of the extent of the history, exam or the medical decision making, if the majority of the encounter involves counseling or coordination of care. Since your visit clearly involved counseling, then as long as the provider documents the total time of the visit and the time spent counseling, you qualify for the time spent as noted under each E/M code in the CPT book (each code has a time value associated with it).

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