Prevention of Fetal Alcohol Spectrum Disorder (FASD) Coding Basics

ICD (International Classification of Diseases) diagnostic codes are used to justify the medical need for procedures and services provided. Healthcare providers must document the reason for every service rendered, ensuring that the codes selected accurately reflect the patient's condition.

Correct use of diagnostic codes should ensure that:

• The code precisely represents the patient's diagnosis and explains the clinical reason for the service or procedure
• The selected code is backed by detailed and accurate documentation in the patient's medical record
• The code aligns with official coding rules and established guidelines

When assigning ICD-10-CM codes for a patient visit, the chosen diagnoses must demonstrate the medical necessity of the services reported with CPT codes.

Essential Principles for Accurate Diagnosis Coding

• Assign codes that reflect the most precise level of detail available
• Use codes that represent confirmed diagnoses to the fullest level of certainty
• Ensure each diagnosis code is properly associated with its corresponding procedure code on the claim
• List diagnoses in order of importance, starting with the primary condition and then any additional relevant diagnoses
• Report only those diagnoses that are pertinent to the current visit or treatment session

Diagnostic Codes to Be Used on the Maternal Record Only

Conditions impacting pregnancy, delivery, and the postpartum period are categorized under codes O00–O9A, found in Chapter 15 of the ICD-10-CM. These codes take priority over others when applicable, but may be supplemented with codes from different chapters for added clarity or detail. Chapter 15 codes are specifically designed for documenting the mother's health and are assigned only to the maternal medical record. They should never be used on the newborn's chart.

Alcohol Screening and Related Diagnostic Coding

When documenting encounters related to alcohol use screening, the following ICD-10-CM codes may be appropriate:

• Z13.89 – Encounter for screening for other specified conditions

Used when conducting general screenings, including alcohol use, where no specific disorder is identified at the time of the visit.

• Z02.83 – Encounter for blood-alcohol and drug testing

This code applies when tests are performed to detect the presence of alcohol or drugs in the system. If results indicate the presence of substances, an additional code should be added to identify the specific findings (e.g., R78.- for the presence of a substance in the blood).

Note: The hyphen “-” indicates that more characters are needed to specify the diagnosis code fully.

Related Signs and Laboratory Findings

• R78.0 – Alcohol identified in the bloodstream

When this code is reported, include an external cause code (from category Y90.-) to specify the exact blood alcohol level.

Alcohol Use During Pregnancy

In cases where alcohol consumption occurs during pregnancy or the postpartum period, diagnostic coding should reflect the impact on maternal health. Use a code from subcategory O99.31-, which denotes alcohol use complicating pregnancy, childbirth, or the puerperium.

Additionally, assign a secondary code from category F10 to represent the specific alcohol-related disorder or manifestation, thereby ensuring a more complete and accurate clinical picture.

Procedure Coding Overview

Procedure codes, including Evaluation and Management (E/M) codes, are used to document the services or procedures provided during a patient encounter. The appropriate code selection depends on the nature of the visit, whether it is screening or treatment.

Preventive Medicine Codes

Used when the encounter is for screening and counselling:

• Individual Counselling:
  • 99401–99404 – Preventive medicine, individual counselling (time-based)
• Group Counseling:
  • 99411–99412 – Preventive medicine, group counseling (time-based)

Reimbursement eligibility for these codes varies depending on the payer.

Substance Abuse Counselling Codes

Specific CPT codes for alcohol or substance abuse screening and brief intervention:

• 99408 – Alcohol/substance abuse structured screening (e.g., AUDIT, DAST) with brief intervention, 15–30 minutes
• (Do not report if less than 15 minutes)
• 99409 – Same as above, but greater than 30 minutes
• (Do not report 99409 with 99408; use only for initial screening and brief intervention)

Procedure Coding for Alcohol-Related Encounters

Procedure codes help document the type of service provided during a patient visit. Coding depends on whether the encounter is for screening or treatment.

Preventive Counseling (Screening)

Use Preventive Medicine codes when the visit is for screening and counseling without a diagnosis of alcohol use, abuse, or dependence.

Individual Counseling:

• 99401–99404 – Preventive medicine counseling, individual (time-based)

Group Counseling:

• 99411–99412 – Preventive medicine counseling, group (time-based)

Reimbursement may vary by payer.

Alcohol/Substance Abuse Screening & Brief Intervention (SBI)

Use these codes for structured screenings like AUDIT or DAST, with brief interventions:

• 99408 – SBI, 15–30 minutes
• 99409 – SBI, greater than 30 minutes

Only one (99408 or 99409) can be reported per visit. Do not report for <15 minutes.

Treatment Encounters with Diagnosis of Alcohol Use, Abuse, or Dependence

If the encounter is for treatment and the patient has a diagnosed condition, report an E/M office or outpatient visit code.

New Patients:

• 99201–99205 – Office or outpatient visit, new patient

Established Patients:

• 99211–99215 – Office or outpatient visit, established patient

If more than 50% of the total visit time is spent on face-to-face counseling and the time is documented, E/M codes may be selected based on the time spent rather than the history, exam, or decision-making.

Medicare Coverage for Alcohol Misuse Screening and Counseling

Medicare provides coverage for alcohol misuse screening to all beneficiaries. Individuals who screen positive who misuse alcohol but do not meet the criteria for dependence are eligible for counseling, provided they are alert and competent during the session. Counseling must be delivered by a qualified primary care physician or practitioner within a primary care setting.

Screening and Counseling Codes

G0442

Annual alcohol misuse screening

Duration: 15 minutes

May be billed once per year

Documentation in the medical record must support all coverage requirements

G0443

Brief face-to-face behavioral counseling for alcohol misuse

Duration: 15 minutes

Up to four sessions may be billed per year for those who screen positive

No deductible or coinsurance applies

There are no specified time intervals required between sessions

Additional Medicare Codes

G0396

Alcohol and/or substance (excluding tobacco) abuse structured assessment and brief intervention

Duration: 15 to 30 minutes

Examples of assessment tools include AUDIT and DAST

G0397

Alcohol and/or substance (excluding tobacco) abuse structured assessment and brief intervention

Duration: greater than 30 minutes

Also includes the use of tools such as AUDIT and DAST

Drug Screening CPT Codes

80305

• Presumptive drug test for any number of drug classes
• Read visually (e.g., dipsticks, cups, cartridges)
• Includes sample validation when performed

80306

• Presumptive drug test for any number of drug classes
• Read using instrument-assisted optical observation
• Includes sample validation when performed

80307

• Presumptive drug test for any number of drug classes
• Performed using instrument chemistry analyzers, chromatography, or mass spectrometry
• Includes sample validation when performed

Medicaid Codes

H0049

Alcohol and/or drug screening

H0050

Alcohol and/or drug service, brief intervention, per 15 minutes

Preventive Services

Preventive Medicine Services fall under Evaluation and Management (E/M) and do not require a chief complaint. There are two categories of preventive services.

Preventive Medicine Evaluation and Management services are reported as follows:

Code

Initial comprehensive preventive evaluation and management of an individual, including an age- and gender-appropriate history, examination, counseling, anticipatory guidance, risk factor reduction interventions, and ordering of laboratory or diagnostic procedures for a new patient

Preventive Services

Preventive Medicine Services are a type of Evaluation and Management (E/M) service and do not require a chief complaint. These services focus on comprehensive preventive care based on the patient's age and gender.

Initial Preventive Medicine Evaluation and Management Services (New Patients)

These are reported as follows:

Code: 99384

Age Group: Adolescent (ages 12–17 years)

Code: 99385

Age Group: 18–39 years

Code: 99386

Age Group: 40–64 years

Code Description:

Initial comprehensive preventive evaluation and management of an individual, including an age- and gender-appropriate history, examination, counseling, anticipatory guidance, risk factor reduction interventions, and ordering of laboratory/diagnostic procedures for a new patient.

Preventive Services

Preventive Medicine Services are a category of Evaluation and Management (E/M) services that do not require a chief complaint. These services focus on preventive care tailored to age and gender and are billed accordingly, depending on whether the patient is new or established.

Initial Preventive Medicine E/M Services (New Patients)

Code: 99384

Age Group: Adolescent (ages 12–17 years)

Code: 99385

Age Group: 18–39 years

Code: 99386

Age Group: 40–64 years

Code Description:

Initial comprehensive preventive evaluation and management of an individual, including an age- and gender-appropriate history, examination, counseling, anticipatory guidance, risk factor reduction interventions, and ordering of laboratory or diagnostic procedures for a new patient.

Preventive Medicine E/M Services (Established Patients)

Code: 99394

Age Group: Adolescent (ages 12–17 years)

Code: 99395

Age Group: 18–39 years

Code: 99396

Age Group: 40–64 years

These codes are used to report annual well-woman examinations. The appropriate code depends on the patient’s age and whether she is a new or established patient to the physician or practice.

Included Services:

• Comprehensive history and examination
• Counseling, anticipatory guidance, and risk factor reduction
• Ordering of immunizations or diagnostic/lab procedures
• Treatment of minor or incidental findings

Since counseling and risk factor reduction are already included in preventive visits, reporting separate counseling codes for the same encounter may result in non-reimbursement.

Medicare does not cover preventive services billed under CPT codes 99384–99396.

Counseling Risk Factor Reduction and Behavioral Change Interventions

These services are reported with CPT codes 99401–99412. They are used when the patient has no current symptoms or diagnosis, and the focus is on health promotion and disease prevention.

Example: A physician spends 30 minutes discussing diet, exercise, or pregnancy planning with a patient. The appropriate code would be:

CPT Code: 99402

Preventive medicine counseling; approximately 30 minutes

These services must occur separately from the preventive medicine visits (99384–99396).

If another E/M service is provided during the same visit, it must be distinct and supported with a different diagnosis code.

Do not use 99401–99412 if the patient has symptoms or a diagnosed condition. In such cases, a problem-oriented E/M code (99201–99215) should be reported.

Behavioral change interventions may be used for issues such as alcohol or substance abuse, where the behavior itself is considered a medical concern. If billed on the same day as another E/M service, both services must be documented and distinct; time spent on counseling cannot be used toward E/M level selection.

Group Counseling

For group educational sessions on specific topics (e.g., prenatal care, obesity, diabetes), use:

Code: 99078

A physician or qualified healthcare professional provides educational services in a group setting.

Note: Prenatal care may be billed using global OB package codes or on a separate per-service basis, depending on the payer and documentation.

Global Obstetric Package Codes

The following CPT codes represent routine obstetric care, including antepartum, delivery, and postpartum components, bundled into a global package:

Code: 59400

Routine obstetric care, including antepartum care, vaginal delivery (with or without episiotomy and/or forceps), and postpartum care

Code: 59510

Routine obstetric care, including antepartum care, cesarean delivery, and postpartum care

Code: 59610

Routine obstetric care, including antepartum care, vaginal delivery (with or without episiotomy and/or forceps), and postpartum care following a previous cesarean delivery

Code: 59618

Routine obstetric care, including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after a previous cesarean delivery

Third-party payers may have varying policies on how obstetric services should be reported. Specific reporting guidelines may differ by payer.

Each Service is Coded Separately

Some third-party payers do not accept global obstetric package billing and instead require each component of care to be reported individually. Variations in reporting may include:

• Submitting a separate claim for each service as it occurs
• Submitting one claim per trimester, listing all services provided during that trimester
• Submitting one claim after delivery, with each service itemized separately

By Trimester: Some payers specifically require obstetric services to be billed per trimester, with services grouped and submitted accordingly.

By Trimester

Some payers require obstetric services to be submitted separately for each trimester of pregnancy. Any additional services outside the global obstetric package must be included on the claim corresponding to the trimester during which they were provided.

After Delivery

Certain payers only accept obstetric service claims after delivery has occurred. These claims may also require a diagnosis code from the Z37 series (Outcome of Delivery) to be included.

Using HCPCS Codes

Many state Medicaid programs require obstetric services to be billed using HCPCS Level II codes, often on a service-by-service basis. Under HIPAA regulations, all payers are required to use a standardized set of Healthcare Common Procedure Coding System (HCPCS) codes.

Example:

Code: H1000 - Prenatal care, at-risk assessment

 

About the Fetal Alcohol Spectrum Disorders Program

The Centers for Disease Control and Prevention (CDC) advises that no amount, timing, or type of alcohol is considered safe during pregnancy. Alcohol consumption at any stage of pregnancy may lead to Fetal Alcohol Spectrum Disorders (FASDs)—a group of lifelong conditions that can include:

• Growth deficiencies
• Characteristic facial abnormalities
• Central nervous system dysfunction
• Behavioral and emotional disorders
• Impaired cognitive and intellectual development

The Fetal Alcohol Spectrum Disorders Prevention Program is a CDC-funded initiative managed by the American College of Obstetricians and Gynecologists (ACOG), aimed at promoting prevention and awareness among healthcare providers and patients.

BillingFreedom: Expert OBGYN Medical Billing for Preventive and Obstetric Care

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Our experienced team understands the unique needs of OB practices, from documenting well-woman exams to managing claims related to behavioral interventions and delivery outcomes. BillingFreedom reduces claim denials, minimizes billing errors, and enhances revenue flow, allowing your staff to focus on patient care. With our reliable billing support, your practice stays compliant, efficient, and fully aligned with payer expectations.

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