Poll

Patient came for preconception counseling, claim was denied when V25.4 was used with a CPT code of 99204

ICD
0 (0%)
CPT
0 (0%)

Total Members Voted: 0

Author Topic: Preconception Counseling  (Read 8649 times)

ravik

  • Newbie
  • *
  • Posts: 2
Preconception Counseling
« on: July 07, 2009, 07:28:28 AM »
 kindly suggest the correct ICD and CPT codes

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4710
    • Solutions Medical Billing
Re: Preconception Counseling
« Reply #1 on: July 07, 2009, 08:49:38 PM »
I think the ICD9 you are looking for is V26.4 - Procreative Management, General Counseling and Advice.  As for the CPT code, it depends on who is performing the service.  If it is a mental health provider then you would use one of the counseling codes 90801-90847.  If it is a medical provider you might want the consultation codes 99241-99275.

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Pay_My_Claims

  • Guest
Re: Preconception Counseling
« Reply #2 on: July 07, 2009, 08:52:02 PM »
**snicker** Sorry but I just had to

ravik

  • Newbie
  • *
  • Posts: 2
Re: Preconception Counseling
« Reply #3 on: July 08, 2009, 07:31:06 AM »
Michelle

  We coded 26.4 with 99204, claim returned saying they don't cover routine exams and it is patient responsibility, service has been provided by a OB/GYN Physician at her office.

Thanks
Ravi

PMRNC

  • Hero Member
  • *****
  • Posts: 4218
    • One Stop Resources & Networking for Medical Billers
Re: Preconception Counseling
« Reply #4 on: July 08, 2009, 08:55:29 AM »
That could very well be as some plans do not cover preventative screenings/visits. If the claim was denied but was coded correctly the patient would be responsible for payment.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4710
    • Solutions Medical Billing
Re: Preconception Counseling
« Reply #5 on: July 09, 2009, 07:06:55 AM »
Linda is right, it sounds like the service is just not a covered benefit under the patient's plan.

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

midwifebiller

  • Full Member
  • ***
  • Posts: 154
Re: Preconception Counseling
« Reply #6 on: July 13, 2009, 10:25:01 AM »
We bill for preconception counseling fairly regularly. V25.4 is incorrect. 1) it needs a fourth digit and 2) this code is for contraception surveillance (checking an IUD, giving another Depo shot or re-issuing a rx for the Pill, etc.) and is not a good code to use for preconception counseling.  We use V25.09 (Family Planning Advice).

We have also found that only a very robust insurance plan will cover preconception counseling--most of the time the member will need to pay out of pocket.

~Kelli
Midwife Billing & Business, LLC
Kelli Sugihara, CPMB
Midwife Billing & Business, LLC
www.midwifebilling.com

Pay_My_Claims

  • Guest
Re: Preconception Counseling
« Reply #7 on: July 13, 2009, 11:36:56 AM »
midwife, you really seem to know your stuff!! never dealt with that part of billing,

midwifebiller

  • Full Member
  • ***
  • Posts: 154
Re: Preconception Counseling
« Reply #8 on: July 17, 2009, 03:05:47 AM »
Ah shucks, ya made me blush.  :-)
Kelli Sugihara, CPMB
Midwife Billing & Business, LLC
www.midwifebilling.com