Coding Cues

April 6, 2007

Answers to your questions about...additional consults, preventive counseling, office stress tests

Additional consults

I saw a patient in my office in January for a consultation, and then again a few weeks ago for another consult. How often can I submit consult codes for the same patient? Can I bill a consultation for both visits?

As with the original consultation, when you perform an additional consult for a given patient, be sure you meet all of the consultation requirements: the request documented in the medical records of the requesting and the consulting physician, the patient evaluation, and the report returned to the requesting provider.

Preventive counseling

I spent 30 minutes with an established patient discussing and prescribing birth control pills during a preventive medicine counseling session. I went over the differences between the pill, the patch, and other birth control devices as well. Which ICD-9-CM codes should I report for the visit?

Report 99402 (preventive medicine counseling . . .) and link it to V25.01 (encounter for contraceptive management . . . ).

Because 99401-99404 (preventive medicine, individual counseling) are time-based codes, you must document the amount of face-to-face time spent counseling. You'll stand a better chance of convincing payers to reimburse you for the counseling if you're able to provide particulars on the content of the discussion and reason why you prescribed a certain contraceptive. Your documentation for the counseling visit should include references to pamphlets or other materials you reviewed with the patient.

Office stress tests

I administered a stress test to a patient in my office, but I don't own the equipment. Should I report 93015–26 for this service?

No. Although it's normally correct to use modifier –26 (professional component) to indicate that only the professional component of a procedure was provided, using this modifier with 93015 would be inappropriate because other cardiovascular stress test codes better describe your work supervising and, or, interpreting the test.

Code 93015 (cardiovascular stress test using maximal or submaximal treadmill . . . ) is the global code that describes the test's professional components-your supervision, interpretation, and report-as well as the technical component. You'd submit this code if you or your practice owned the equipment and you performed all the work.

If you don't own the equipment, the code is unbundled in one of the following ways:

This information is adapted from material provided by The Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact The Coding Institute, 2272 Airport Road South, Naples, FL 34112; phone 800-508-2582; fax 800-508-2592; or visit http://www.codinginstitute.com.