Do you ever meet with parents before their baby is even born? In these cases, you might be hesitant to charge for the visits because the patient isn’t present yet—but can you collect anything for the physician’s time? Check out the following 4 options, along with our expert advice before billing to insurance.
1. Consider an Office Visit
Some practices think of meet-and-greets, in which they tell the parents about the way they run their practice, more as an office visit, such as 99201. However, this would need to be billed based on time to the mother’s insurance company and would likely be questioned by the insurance company. For practices that do charge for these services, there’s a diagnosis code you can use: V65.11. ICD-9 guidelines allow you to list the code as a first or additional diagnosis.
2. Ensure You Meet Criteria Before Using 99401-99404
As an alternative to use a problem-oriented office visit code, the American Academy of Pediatrics (AAP) suggests the pediatrician may deem an appropriate counseling or risk factor reduction code. You may report these codes for prenatal counseling “if a family comes to the pediatrician/neonatologist either self-referred or sent by another provider to discuss a risk-reduction intervention (i.e., seeking advice to avoid a future problem or complication),” according to the AAP’s Coding for Pediatrics 2009.
You would report the service under the mother’s insurance, according to the AAP. Make sure you don’t use 99401-99404 if the mother or her fetus has any existing symptoms, an identified problem, or a specific illness. As per CPT®’s Counseling Risk Factor Reduction and Behavior Change Intervention guidelines, “these codes are used to report services for the purpose of promoting health and preventing illness or injury.”
Codes 99401-99404 aren’t necessarily shoo-ins for typical meet and greets. The AAP gives the following examples of prenatal counseling encounters that qualify for 99401-99404.
Scenarios include a mother with:
- A history of hypertension or diabetes
- A family history of a genetic disease
- A history of a premature neonate.
Most insurers do not pay 99401-99404. If, however, you have an insurer that covers the codes and you’ve met the above requirements, choose the appropriate code based on the prenatal counseling session’s time.
The medical record must include “documentation of the total counseling time and a summary of the issues discussed.” Check out the academy’s appropriate documentation example for 99401: “I spent 15 minutes with both parents reviewing the risks of recurrent preterm delivery and the mortality and morbidity risks if delivery occurs at less than 36 weeks.”
3. Limit Consults When Mother Has a Problem
You’ll have an easier time giving the green light to coding for a prenatal visit in which another physician asks you to meet with the expectant mother. For insurers that still accept consultation codes (99241-99245, Office consultation for a new or established patient …), you can report the appropriate code from this range with a report back to the ob-gyn if the ob refers the patient to you and asks you to meet with the patient. This consultation would again be billed under the mother’s insurance if the baby is still in uterus.
“If an ob refers the patient to me I could technically bill a consult code but it would have to be totally time-driven because a pediatrician isn’t going to examine an expectant mother,” says Richard Lander, MD, FAAP, medical director with Essex-Morris Pediatric Group in New Jersey.
In these cases, the mother may be angry about you charging her a copy for the visit. Explain that co-payments are an issue between the insurance holder and the insurer. Your office must follow these contractual agreements.
4. Think of Get-Acquainted Visits as Good PR
Some pediatricians simply consider doing meet-and-greets as good public relations (PR) and consider them a practice builder. “We don’t charge patients or the insurance for these visits,” Lander says. “The visits can get time consuming if you let them—several years ago, I was seeing maybe four or five prenatal visits a week.”
Therefore, Lander uses a strategy that ensures that the visit won’t span longer than 20 minutes. “I introduce myself, tell them about our basic philosophies, ask them a few questions (for instance, whether there are any genetic diseases in the family, if they’ll be breastfeeding, if they plan to circumcise), talk to them about how our practice does not rush to give meds, and explain our other policies, and that way, most parents don’t have many questions since I already gave a detailed explanation.” For those parents who do pull out a list of questions, Lander tells them he needs to get back with his patients, so he’s happy to answer the parents’ top two questions.
If you decide not to bill for the service to the parent or the insurer, you might want to create an internal reporting code, which is used to gather data that you can use to evaluate meet-and-greets’ value. You can later analyze the information to determine how many patients actually joined your practice following the meet-and-greet.
