Family physicians can get paid for common services such as counseling and screenings. The key is recognizing them and knowing how to code them.
Primary care physicians often provide more care than the evaluation and management (E/M) services they typically bill for,1 but many are not familiar enough with the additional services to document and bill for them.
The most common missed opportunities in primary care involve counseling or preventive services, but there are other billable services physicians may be missing out on as well. Once you recognize these services, the key to preventing denials is understanding what diagnosis codes and documentation payers require. Then, you can link the diagnosis codes to the CPT codes in the EHR and make templates to streamline the documentation process.
This article covers several CPT and HCPCS codes for services family physicians often provide but less commonly bill.
KEY POINTS
- Services such as tobacco cessation counseling and intensive behavioral therapy for obesity are appropriate for many patients and can be billed separately from evaluation and management.
- The key to avoiding insurance denials when billing these services is knowing which diagnosis codes to use and how to document your work.
- While the relative value units tied to some of these services may be small, they can add up quickly, and in many cases primary care physicians may already be doing the work and just not billing for it.
BE AWARE: PAYER POLICIES MAY DIFFER
Before we get to the services and codes, first we must note that payer policies for billing these services may differ. Medicare has an online list of covered preventive services with coverage guidelines,2 and Medicare policies will be cited below, where applicable. Commercial payers often follow Medicare policies regarding which ICD-10 codes are associated with which services, but often use different procedure codes. Medicare and Medicare Advantage plans generally use HCPCS codes that start with G (e.g., G0402 for initial preventive physical exams, and G0438 and G0439 for annual wellness visits) while commercial payers use CPT codes (e.g., 99381-99387 and 99391-99397 for annual routine physical exams). When there is no G code or no CPT code for a particular service, then payers will usually cover the other code type.
It’s best to obtain payer policies for each payer you work with on a regular basis. Large practices may have revenue cycle teams or coding teams that can assist with this. You can usually find payer policies by searching online for the specific code and payer or logging into the payer’s provider portal, which will have a list of all the medical policies with reimbursement guidelines.
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