Billing For Visits When Counseling/Education is the Reason for the Visit

The same code is used for a New Patient or an Established Patient.

99401    15 min.
99402    30 min.
99403    45 min.
99404    60 min.

These codes should be used for New Patients who do not present with a problem. The same codes are used for new and established patients. Generally the V codes for counseling are used.

Developmental Screening (Massachusetts Specific):

All children under the age of 21 are mandated to have a developmental screening at their physical. The codes used to report that is this has been done are divided by the type of provider that sees the patient, and if the child is in need to services or not. If factors are identified, and the child is already receiving service, they still found to be in need of services. The purpose of these codes is to identify how many children in the commonwealth need services. The codes to be used in community health centers are:

Physicians                            No need found    96110-U1
                                                In need of services 96110-U2

Nurse Practitioners             No need found 96110-U5
                                               In need of services 96110-U6

Physician Assistants        No need found 96110-U7
                                             In need of services 96110-U8

Emergency Situations 

When a patient is transferred to a hospital via ambulance, and the purpose is because the patient’s condition is serious and time is important, it should be reported as a 99215. The rational for the ambulance transfer must be documented. If you have unable to get a complete history and/or Review of Systems, it should be noted why you were unable to get this. This is not to be used in situations where transportation is needed for non-life-threatening situations.

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