Insurance Billing and Counseling

Here you will find a few facts concerning billing report of findings and counseling.

Defining the difference between report of findings and counseling

Report of Findings : Informing the patient of his condition and treatment options - sometimes is performed on the same visit as the initial exam and sometimes it is reserved for the next visit.

Counseling occurs after your patient's treatment plan has started and your patient has asked for clarification concerning their condition, symptoms or any other issues that can surface in the course of treatment.

Billing Guidelines for Counseling:

1. You cannot counsel on the first visit in conjunction with the exam.
2. The time you spend counseling your patient must take up over 50% of the total session length.
3.  You must have discussed one or more of the following with your patient.

• Diagnostic results, impressions and/or recommended diagnostic studies (Report of Findings)
• Prognosis
• Risks and benefits of treatment options
• Importance of compliance with chosen treatment options
• Risk factor reduction
• Patient and family education Time is the controlling factor in these codes, it is important that you document your time

Report of Findings: You cannot bill Report of Findings on the same day as a new patient exam. If you do your report on the same day that you examine your patient, then you only need select the proper New Patient Exam Code. These are 99201-99204. The higher number of the code, the more in depth the exam, covering all of the key components listed below.

If on the second visit you want to bill Report of Findings, the proper codes are 99212-99214, and once again, the higher the number, more more in depth the report. In addition, your session needs to include at least two of these three components:

• History
• Examination
• Clinical Decision Making

And of course, you need to document these two things.  Documentation is essential.  As Medicare has stated, "If you didn't write it down, it didn't happen."

Disclaimer: This page is for information only and is not a coding or billing advice or guideline. PracticeSuite does not warrant or imply as to its accuracy or validity.