Clinical Chats: a Podcast for Sexual and Reproductive Health Professionals · Clinical Training Center for Sexual and Reproductive Health

Coding with Ann Episode 24: Updates on Common LARC Miscodes

·22 min·1 clip

Maggie’s visit codes to 99204 as a new patient, or 99214 if she were established.

1. Clinical Chats: a Podcast for Sexual and Reproductive Health Professionals covers common LARC miscodes in "Coding with Ann Episode 24: Updates on Common LARC Miscodes." 2. Catherine hosts Anne Finn, a healthcare reimbursement consultant and national trainer who leads Anne Finn Consulting LLC. 3. The episode is built to show how to code IUD and implant services correctly so clinics capture reimbursement and avoid payer take-backs. 4. Maggie, a 19-year-old new patient, wants contraception, receives counseling, has a urine pregnancy test, gets chlamydia and gonorrhea screening, and then has an IUD inserted the same day. 5. Finn says that scenario can require a separate E&M visit code, a procedure code, a device supply code, and point-of-care testing codes. 6. She notes that CPT or payer rules may allow preventive E&M codes like 9938 or problem-oriented codes like 99203 and 99214. 7. Finn emphasizes that new versus established status affects payment and can be checked in the EHR, front-desk workflow, or prior chart history. 8. She gives the CPT definition of a new patient as someone with no professional services from the same specialty or subspecialty in the same group within the past three years. 9. She says the January 2021 E&M updates require counting total time on the date of the encounter, not only face-to-face time. 10. Finn lists review of prior notes, lab results, EHR documentation, contraception orders, lab ordering, and coordination of care as time that should be counted. 11. She says the best practice is to document both total time and medical decision-making, then select the higher supported code. 12. For Maggie’s MDM, Finn identifies a single low-level problem, three data points from the pregnancy test and STI tests, and moderate risk from a prescription-level contraceptive. 13. That combination leads her to choose 99204 for a new patient and 99214 for an established patient. 14. Finn draws a bright line between a separate billable E&M service and routine questions that are part of a scheduled procedure. 15. She says modifier 25 must be attached when the E&M is truly separate from the LARC insertion, or the payer often bundles the services. 16. For an IUD exchange, she reports CPT 58301 for removal and 58300 for reinsertion, and she says modifier 51 or 59 affects whether the second procedure pays separately. 17. For a stopped insertion, she says modifiers 52 or 53 can still support payment when the clinician had to stop because of pain or another problem. 18. The tone is instructional and chart-focused, with repeated billing examples, code numbers, and payer workflow advice. 19. Billing staff, family planning clinicians, and coders who handle LARC claims will get the most value. 20. People seeking clinical contraception counseling rather than reimbursement details may skip it.

Listen to the show on

Apple Podcasts Spotify

Play clips from this episode More from Clinical Chats: a Podcast for Sexual and Reproductive Health Professionals