Coding for Additional Work During Preventive Medicine Examinations
Current Procedural Terminology guidelines for preventive medicine services include an age- and a gender-appropriate history, examination, and anticipatory guidance; counseling and risk factor reduction interventions; and the ordering of appropriate laboratory tests and immunizations. These codes are not time-based; therefore, it is difficult to discern when you should and should not be reporting another evaluation and management (E/M) service in addition to the preventive medicine examination.
Many times during a preventive medicine examination, certain
issues are brought up by a parent or simply through casual questions that take
time to address. That does not always mean that the service should be reported
Issues to consider when determining if another E/M service is warranted are the following:
· Was the service significant and separate?
· Did I meet the minimum criteria for reporting the E/M service (either through key components or time spent counseling)?
Was this medically necessary?
If you answer “yes” to all 3, you have enough documentation
to support the additional reporting of the E/M service.
In the scenarios on this sexual violence prevention CD-ROM, those
marked with a green or yellow light do not support the reporting of an E/M
service in addition to the preventive medicine service.
However, the red-light visits do. In these scenarios there is
enough information to support a separate E/M service. To support that, however,
the physician will need to have documentation to show that the counseling
service took place separately from the preventive medicine service. It must be
clearly documented how much time was spent counseling; also, be sure the time
spent performing the preventive medicine service is not included. The
documentation will need to clearly state what was talked about and any other
issues and follow-up. Your International Classification
of Diseases, Ninth Revision, Clinical Modification code will support the additional reporting as well.
Please be sure to report the E/M service (99201–99215) with modifier 25 appended.