Coding & Documentation

It is appropriate to report 99401-99404 for lifestyle counseling visits that address risk-factor reduction in patients with overweight and/or sarcopenia. However, payment for these services may differ by health plan. Policies that limit coverage of these visits to specific diagnoses often include only obesity (body mass index ≥30, coded with ICD-10 Z68.30-Z68.45), not overweight (BMI 25.0 to 29.9, coded with Z68.25-Z68.29) or sarcopenia (M62.84). But if you address overweight or sarcopenia during a visit for a related health condition (e.g., prediabetes), it would be appropriate to include your counseling time in the total time of the E/M for the related condition. In that case, do not report the counseling separately.

No code changes took effect this spring. However, some “Excludes1” notes (indicating codes not reported together) have been changed to “Excludes2” (indicating conditions not reported with the code to which the note applies but reported separately when diagnosed). For example, previously the ICD-10 code for heartburn (R12) listed an Excludes1 note for dyspepsia (R10.13), meaning the two codes could not be reported together. But now you should report management of both dyspepsia and heartburn with the ICD-10 codes for each condition. This is important when a payer uses claims-processing algorithms that deny services reported with diagnosis codes that have Excludes1 notes.

Look for new, revised, and deleted ICD-10 codes in the annual update on Oct. 1. For a summary of the October 2025 update, see this FPM Getting Paid blog post.

Report a single code from 99421-99423 for the cumulative service time within the seven-day service period that started on the day of the first online digital E/M service. This is the rule regardless of whether the problem is new or related to the problem you addressed during the first online digital E/M service.

If you've already submitted a claim for the first service, you may have to follow the payer's instructions for reporting a corrected claim (e.g., to replace a claim for 99421 with a claim for 99422 or 99423).

You can report a separate online digital E/M service only if you provide it more than seven days after a previous E/M service — whether online or in person.

Nothing in CPT directly prohibits this. However, there are some important things to consider:

• Recommended preventive services, such as tobacco cessation counseling, typically have no out-of-pocket costs to patients. E/M codes, on the other hand, often include patient cost sharing.
• You can bill for services such as tobacco cessation counseling even if they require less than 10 minutes of physician time — an amount that may not increase the level of E/M service.
• With some payers automatically down-coding office E/M services, reporting the office E/M alone (even at a higher level to include the preventive service) may ultimately lead to lower payment than reporting both services separately.