You may bill a sick visit with a well child visit if there is a distinct, separately identifiable E/M service that requires additional work to perform the key elements of an E/M service. If it is a minor, insignificant problem that was addressed during the well child visit, it is not separately billable. The key here will be the Dx that is mapped to the sick visit and the medical management for that dx. Most payers will pay for both services if it is justified, but will make a reduced payment for the sick E/M. You need to add modifier 25 to the sick E/M, but a lot of payers need mod 25 on BOTH, the well-child visit and the sick visit. Per coding rules this is incorrect, but payers have their systems set up in a way that if you don't add mod 25 to both services, they get bundled. Providence does not pay for sick visits with well child checks, no matter what. BCBS does pay. Yes, there have been many instances when parents have called in to complain about copays with the sick visit because in their mind, they were coming in for a well child check and they just discussed issues during the well child check. This is why it is important to make sure the sick visit was truly justified and that there was a completely separate History, Exam and MDM that was done for the presenting problem. Also, ideally the provider needs to inform parents during the visit that if a separate issue is discussed and treated, there could be a copay for that part of the visit.Does anyone in primary care pediatrics bill well child visits with sick visits at the same time? Do you have a problem getting paid for both? Do you have a problem with patients paying copays for the sick visit? I am hearing that BCBS pays a reduced well visit fee if submitted with sick visit codes, but I cannot find actual documentation. Any guidance would be greatly appreciated.