This modifier is key to E&M and counseling codes cohabiting on your claim.
Question: Can I report alcohol cessation counseling codes along with E/M codes, or do I have to choose one or the other?
Idaho Subscriber
Answer: You can, and in most cases will, report counseling codes along with E/M services. The behavior change intervention codes are intended to be reported in addition to an E/M service when the provider furnishes them. Most counseling sessions occur after the provider performs some sort of E/M. Consider this case study:
A new patient presents to the gastroenterologist reporting intense heartburn and “vomiting bile” for about a week. The patient’s skin is a splotchy yellow, and he reports experiencing generalized fatigue “for as long as I can remember.” Due to the smell of alcohol and the patient’s symptoms, the physician asks the patient if he has been drinking. The patient says “Yes,” so the physician decides to conduct the CAGE test to gauge alcohol abuse
Based on the test results, the physician determines that the patient is at least moderately dependent on alcohol; she performs extensive counseling and recommends the patient start attending Alcoholics Anonymous or some other community support group for alcohol-addicted individuals.The physician then finishes her patient exam.
She also recommends that the patient schedule a follow-up visit for a cirrhosis screening. The alcohol counseling lasted 18 minutes, and notes indicate the physician also performed a level-two E/M.
In this instance, the gastroenterologist performs both an E/M service and alcohol counseling. On the claim, you would report the following:
- 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and straightforward medical decisionmaking…) for the E/M;
- modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99202 to show that the E/M was a separate service from the counseling;
- 787.04 (Bilious emesis) appended to 99202 to represent the vomiting;
- 787.1 (Heartburn) appended to 99202 to represent the heartburn;
- 782.4 (Jaundice, unspecified, not of newborn) appended to 99202 to represent the skin condition;
- 780.79 (Other malaise and fatigue) appended to 99202 to represent the patient’s fatigue;
- 99408 (Alcohol and/or substance [other than tobacco] abuse structured screening [e.g., AUDIT, DAST], and brief intervention [SBI] services; 15 to 30 minutes) for the counseling service; and
- 305.00 (Alcohol abuse; unspecified) appended to 99408 to represent the patient’s alcohol dependence.
@ Gastroenterology Coding Alert. Editor: Chris Boucher, CPC
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