Primary Care Coding Alert

Question: We often bill well woman and sick visits on the same day if the sick visit warrants a separate code. We use a modifier 25 with the E/M code. One of our insurance carriers recently started processing the E/M code at 50 percent of the allowable and states, "This procedure has been paid at 50 percent of the reasonable and customary rate, due to multiple procedures performed on same date." Does that multiple procedure rule apply to E/M codes? Should I just tell my physicians to reschedule the well check and E/M visits for two separate dates, so that we don't run into this problem?New Hampshire Subscriber Answer: E/M services and multiple procedures do not have the same CPT® rules, but payers are free to establish any rules they want in this regard. Most likely, their rationale is that you did not make the appointment twice, did not use [...]