You Be the Coder:
Know the Ropes for Problem Discovered During Well-Visit
Published on Wed Jun 01, 2011
Question: We have a Medicaid patient that came in for a tenyear- old physical and was found to be sick, so we would like to append modifier 25 to report the wellturned- sick visit. Is that accurate?Virginia SubscriberAnswer: Yes. In this situation, you'll report 99393 (Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/ diagnostic procedures, established patient; late childhood [age 5 through 11 years]) with the diagnosis code V20.2 (Routine infant or child health check). This requires that all of the elements of the preventive visit are met, even though the child is ill.In addition, you'll report 9921x-25 (Office or other outpatient visit for the evaluation and management of an established patient; Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or [...]