1. S

    Wiki What is happening with Modifier 33?

    I work in a GI clinic, and we use modifier 33 and modifier PT all of the time. I am now getting claim rejections for these modifiers, that the procedure codes we are using are inconsistent with the modifier used. How are we to let insurances know that these are preventative services?
  2. R

    Wiki Annual woman Exam

    Is screening at the exam separately billable? 49 y/o Patient presents for annual well woman exam. During the vist a gyn and general exam is done. Is is correct to bill the preventative service 99396 and the stool guaiac with cpt 82270/z12.12? commercial payer and private practice. the general...
  3. K

    Wiki COVID testing for asymptomatic Medicare patients

    My practice is getting denials from Medicare for patients who are coming in to get tested to abide by travel mandates in our state, wanting to ensure they don't have the virus before visiting a local family member or just want to be tested for peace of mind. The argument is that the above listed...
  4. baroquecoder

    Wiki Circumcision and Preventative visit

    Chief complaint: weight check & circumcision HPI formula feeding, gaining weight, appropriate responses.. Full ROS; negative as per HPI Exam; comprehensive Procedure note for the circumcision. Assessment plan; patient gaining weight appropriately continue vitamin d exposure with sunlight post...
  5. baroquecoder

    Wiki Preventative Visit and E/M

    Listed in the chief complaint is "cough and wellness check" there is an HPI for the cough and an Exam and ROS. There is a brief "wellness HPI" and mention of vaccines and nutritional guidance my question is does this qualify as a 99392 and 99214 if the patient is presenting with a problem...
  6. K

    Wiki To bill Preventative or Not to bill Preventative???

    I'm running into issues billing for several of my sites... The doctors will have the CC as "follow-up" or "routine" sometimes even "dm check 6-months" and there is always a full workup but the doctor puts like, 7-10 diagnosis codes in there, usually insignificant things like HTN, DM, obesity...
  7. E

    Wiki Would the foster care diagnosis code (Z62.21) be considered a 'abnormal finding'

    Hello I code and bill for a group of pediatricians and we see a fair amount of foster care children. A question came up asking if a well child visit with abnormal findings can substantiate "abnormal" within a visit if the child is from foster care. Previously I thought most codes in the R70-R94...
  8. L

    Wiki Preventative Visits

    I'm really confused here. Hope someone can help. How do you bill for a preventative visit (ie: 99396) when it should include a comprehensive history and exam when the requirement for a comprehensive physical includes a CC and 4 or more elements of HPI or status of 2-3 chronic conditions? See...
  9. E

    Wiki Annual GYN Exam no pap

    If a patient comes in for annual gyn exam not including a pap(just a breast and pelvic exam). Should the preventative medicine code be used? If not what cpt code do we bill? I am thinking the preventative as it is just preventative. The provider is saying no and is concerned that the patients...
  10. A

    Wiki Preventative Visit with E/M

    Under which circumstances could a Preventative Visit/Physical (99396) be billed with a encounter visit such as 99213?
  11. D

    Wiki Preventative Services and Gastro

    I need some advice one of our physicians keeps coding patients visits with a 99387 (preventative medicine) with use of ICD-10 codes: Z86.010 personal history of polyps, or Z12.11 Encounter screening for malignant neoplasm of colon. My issue is some of our patients are Medicare patients and as...
  12. B

    Wiki 99401-99404 Preventative medicine counseling and/or risk factor reduction interventio

    Has anyone used these codes 99401-99404? If so, can you please share how the payer reimbursing the service? Is this being counted as Preventative care on the patient's benefit and if patient only has one preventative care service (99391-99394) in a year, how does 99401-99404 affect the...
  13. S

    Wiki Well Child Visits & 92552

    Hi All, I dont know if this is per insurer or state, but does anyone know where I can obtain a list of what's included in a preventative med code? My doc wants to get 99383 and 92552 (pure tone audiometry) reimbursed...thanks