Coding: Preventive counseling with evaluation and management

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Q: What is the appropriate CPT code to report when firearm-safety counseling and risk-factor reduction for an established patient is performed in conjunction with a problem-oriented E/M service during an outpatient office visit?

A: Codes 99401-99404 (Preventive medicine counseling and/or risk factor reduction intervention) may be reported for firearm-safety counseling and risk-factor reduction in addition to the code that would be reported for the problem-oriented E/M (99202-99215) service during the same encounter. Remember to append modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) should be appended to the code reported for the problem-oriented E/M service. Modifier 25 is appended provided that the service was both significant and separately identifiable in the documentation, as noted in the Counseling Risk Factor Reduction and Behavior Change Intervention subsection in the CPT 2023 code set. Note that merely inquiring about firearms or gun ownership during an E/M service would most likely not meet the criteria for reporting the preventive medicine code unless the time and counseling requirements were both met. Contact your local third-party payers for more information about their requirements when reporting these codes.

99401 – preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 15 minutes

99402 – preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 30 minutes

99403 – preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 45 minutes

99404 – preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 60 minutes

Renee Dowling is a compliance auditor at Sansum Clinic, LLC, in Santa Barbara, California.