99401-99404 Help.

Stonebr

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Can these codes be billed with a preventitive visit and a sick visit (mod 25) on the same day? This MD billed 99396, 99212-25, & 99401. The latter two have a dx of 272.0 with the preventative having the V70.0.
The way I understand it is that counseling is part of a preventitive visit.
Thanks all for your time in advance!
 

dmaec

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in my opinion: (and you didn't post the note so I can't say for certain) - it doesn't appear to have a sick visit - If the patient does have hypercholesterolemia, and it's on going (chronic)... nothing new, I wouldn't call it a "sick" visit and it doesn't justify a extra E/M level to me. Is the patients 272.0 an ongoing issue that is watched by this provider? Does documentation support both services? Can the services "stand alone"? if you score it out does it meet the requirements of a level 2? I've never coded a 99401 with adult preventive visits - only on well child visits - so I don't have any opinion on that ;) sorry...
In short - yes, the preventive and E/M w/mod can be coded/billed same day IF documentatin supports it.
could you post the note? (maybe my opinion might change)
 

Cottrell

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Physical codes include the prev med counseling component so the 99401 would not be seperately billable.
99401 is also not billable with an illness or symptom dx code. They are for patients who do NOT have symtptoms or a defined illness.
Hope this helps with the 99401 question.
 

Stonebr

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:) Thanks Wendy,
What I'm seeing is well visits with the patient overweight (not new), elevated cholesterol level (borderline previously), or chronic illnesses (ie: Sarcoidosis). The MD is then billing the 99401 along with the 99395-99397's or billing the preventative along with a sick for the high cholesterol with a mod. and then adding the 99401 also. Didn't think that was correct.
 
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