Well/Physical and E/M

[JOGelico]

Hello Everyone,
If a patient's reason for a visit is for a physical, but the physician discusses lab results, addresses other problems, etc; can a Well Code (99381-99397) and an E/M visit be coded together? Would the E/M code be coded with a modifier 25?

Any help will be appreciated!
Thanks,
Jessica

[LOVE2CODE]

A Well Code and E/M visit can be coded together; E/M has to have a modifier 25 attached

[S Avara CPC]

Absolutely. The CPT states that if an abnormality is encountered or a preexisting problem is addressed in the process of performing a preventive E/M service, and if the problem is significant enough to require additional work to perform the key components of a problem-oriented E/M service, the the appropriate office visit code should also be reported with modifier 25. You should also code and immunizations and/or diagnostic tests performed.

[JOGelico]

Are these the same codes to use for Medicare patients?

[rfayec]

Some offices will not do both at the same time due to insurance issues. Some companines will not pay both or make it hard to collect. My GYN office gives a form that states they will not do both services on the same day. If a problem arrises during a PE, it's addressed coded and the PE rescheduled.
So, I'd check with the carrier first.

[Lisa Bledsoe]

If you are going to report both an E/M and preventive medicine, be sure to follow the guidelines in CPT. The E/M portion must be significant enough to require additional work to perform the key components of a problem-oriented E/M service." And of course it MUST be well documented.

[racheleporter]

to piggy back off of lisa curtis....please note the dx for the preventative must be different from the dx for the e/m

[acodingangel]

And.......don't forget that Medicare has specific guidelines that must be followed regarding the billing and cost to the beneficiary when they schedule a preventive and end up with both a preventive and 'sick' visit.

Check with your local Medicare Carrier.

Thanks
Tina