Most practices are either unaware of these codes or are uncomfortable using these codes because they are not certain how or in which circumstances they apply.

An example might be where you have provided a level 3 service involving a patient with a newly diagnosed condition that may be detrimental to their health in the long run. Once diagnosed and appropriate tests are done, the time spent with the patient explaining alternatives, results, and advising them of their care etc., and with the patient asking many questions and having concerns, a great amount of time has gone by.

If you select a level 3 evaluation management code (99213), typically this code would allow you 15 minutes face to face with the patient. But in this instance you spent 45 minutes total face to face with this patient. You could bring your level 3 to a level 4 or a level 5, however, the necessity of the level selected may not be there nor appropriate. In this case, you can use the 99354 prolonged service code with total duration of (30-74 minutes), if time spend face to face is accurately documented with medical necessity for the additional time.

The main reason physicians fail to capture this additional revenue for their practices is failure of proper documentation. Remember, that in the event of an audit documentation is always king in the medical practice!! With that will come cash flow.

Let us help you maximize your revenue and grow your practice. We have a billing solution for your unique practice needs. Let us design a cost effective solution for your medical practice!! Contact us at 1.877.666.5279

Quite frequently in our office we see our providers giving us diagnoses that indicate to us that the patient has a tobacco use disorder. This happens across all specialties. Our question would then be, did you counsel or treat for this particular diagnosis?

Typically the answer is yes. But they never think to add the additional code for this service. Providers are either not aware that there is one, or they just feel its part of whatever level code they are using for that particular visit. This is not true if the patient presented with a completely different problem.

We will use two examples one in which the patient came in with chief complaint of coughing and another in which the patient was found to be pregnant.

Patient one presents with a chronic cough. After examination you determine and upper respiratory infection and you find out that this patient is a smoker. Clearly, the patient has a condition that is adversely affected by tobacco use. You should bill a level code, in this case likely a 99213-25 with diagnosis of upper respiratory infection and chronic cough. If you also provided counseling of 3-10 minutes face to face for smoking cessation, you should also bill 99406 with nicotine dependence, and the medically necessary diagnosis requiring the counseling. If you spent greater than 10 minutes use code 99407.

Patient two presents to OB/GYN office with amenorrhea and is diagnosed with pregnancy. During the initial prenatal visit it is determined that the patient is a smoker. The OB/GYN can be paid additionally for doing a screen for smoking status. The following codes apply: 1034F- Current tobacco user, 1035F- Smokeless tobacco user, 1036F- Current tobacco non-user, and the diagnosis would be V22.X or V23.XX. No modifier is needed and this code is billable along with a level code if one is appropriate.

This patient would then also be qualify for smoking cessation counseling with CPT codes as illustrated in the previous paragraph or this patient could be referred out for this service.

What to do next…… add these codes to your EMR systems and/or your encounters, add a separate heading to your systems called Smoking Cessation Counseling to make it separately identified from your E&M service, and lastly don’t forget to use them! Your documentation must include the amount of time spent, and a brief description of the face to face counseling done.

Let’s talk about the financial impact and coverage of these codes. Medicare covers 2 cessation attempts of 4 sessions each per year or a limit of 8 sessions in 12 months.

Medicaid and most other carriers cover these services as well. Reimbursement for the one time tobacco screen of an OB patient reimburses $48.00-$60.00. For the solo OB practice that sees 10 new OB patients per month the additional “found” revenue would be between $5760-$7200 per year. The 99406-99407 reimburses $13.64 and $26.18 per visit, note that this is in addition to your level code. Consider 100 patients counseled for the intensive sessions for the maximum of 8 sessions that’s over $20,000 a year to your practice for services that your probably already providing!!

Regardless, of how large an impact on revenue that one single code makes the lesson to be learned here, and with all of our newsletters, is that capturing ALL services provided has a much greater impact on overall revenue and practice profitability. So keep on reading and each month you will be on your way to a healthier medical practice!

Feel free to contact us toll free at 1.877.666.5279 if you need assistance with any aspect of billing, practice management systems and processes.