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Primary Care Coding Alert

You Be the Coder:

Know the Ropes for Sick Evaluation During Well Visit

Published on Mon Feb 06, 2012

Question: When parents present with infants for regular health checkups at two, four, and six months, our physician spends a lot of time counseling and treating colic and GE reflux. Can we report 99212-25 with the ICD-9 code for colic (789.7) or gastroesophageal reflux (530.81) along with 99391 (linked to ICD-9 code V20.2 for a well baby visit)? Tennessee Subscriber Answer: According to CPT®, you can bill a sick visit (Office or other outpatient services codes 99212-99215) in addition to a previously scheduled preventive medicine service (99381-99387 and 99391-99397) if the presenting problem "is significant enough to require additional work to perform the key components of a problem-oriented E/M service" and modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is attached to the problem-oriented E/M code. As with any problem-oriented E/M service, the key components [...]
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