Preventative care pays. 99401 and others

Did you know that you can get paid for doing the preventative care? You can.

In the CPT book it is called Counseling Risk Factor Reduction and Behavior Change Intervention.

This is a distinct set of codes from the traditional E and M services and can be billed IN addition to the E and M services you provide.

That means, no modifier 25.

The catch?

1. You have to document how much time you spend in preventative care. 99401 is 15 minutes of care.

2. You have to ICD9 code using a V code or a diagnosis code for the preventative care you are providing. Which means on Diagnosis Pointers on the HCFA form, you have to list a pointer.

3. You have to understand preventive medicine counseling and risk factor reduction interventions provided as a separate encounter will vary with age and should address such issues as family problems, diet and exercise, substance abuse, sexual practices, injury prevention, dental health and diagnostic and laboratory test results available at the time of the encounter.

What does this mean? It means that you get paid for performing preventative care. Something you should be doing just about every appointment.

If you are looking on the AAPC listserv it seems that NO ONE is using these codes.

Why not? If you are providing primary preventative care.
i.e. Use condoms, buckle up, adjust water temp, lift with your legs, lose weight
Then you should get paid for these additional preventative services.

The breakdown-
99401 is for 15 minutes of preventative care
99402 is for 30 minutes of preventative care
99403 is for 45 minutes of preventative care
99404 is for 60 minutes of preventative care

So, document what you do and then go ahead and bill for these important code. Remember, an ounce of prevention is worth a pound of cure and some insurers pay that way.