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Billing well visit & sick visit same day


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OK... this situation totally frustrates me and I have a million patient calls after going in for a well visit and being charged for an unexpected copay. :mad:

The provider's bill well visit and sick visit same day, sometimes for as little as a conversation on an additional topic, but do not inform the patient there will be an additional charge.

How do YOU explain the fact that it's ok for providers to bill a well visit and sick visit on the same day? :confused:

Any feedback would be great!!

Lisa, CPC-A


Best answers
Well visit and sick visit same day

Hi Lisa: I understand your frustration! First I'd clarify with my providers that they are indeed performing a completely separate and medically necessary service. I don't think merely discussing a diagnosis with a patient would qualify. When my company developed our AWV template for Medicare we included a prompt to the providers that the patient be informed of a co-pay if a separate service was provided. Here is the CMS blurb on the issue:

Can a physician bill Medicare for a “medically necessary” service and an AWV service when both are furnished during the same encounter?
Yes. The physician should append the code indicating the medically necessary service, e.g. 99213, with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service), in addition to billing the appropriate AWV service. CMS states that it expects that “no component of an encounter attributable to the AWV would be used in determining the level of separate E/M service that would also be reported.”

Good luck.