Wiki Can you bill 99396 and 99211 together?

[Orthocoderpgu]

Patient comes in for a routine exam (Pap and review of mammo and bone density) several labs are done as well as the doc reviewed 13 Rx's that the patient is on. Patient has hypothyroidsim and the TSH level was fine showing that the Rx is working correctly.

I coded this as 99396 with dx of routine exam and 99211-25 for the hypothyroid E/M services.

The NCCI edits don't prohibit these codes being billed together but an auditor thinks that the 99211-25 is not billable.

What do you think out there in coding land?

Thanks for your input!

 

[Allison L. Wickham]

Here are the guidelines used to determine when to bill a Preventive & E/M on the same date of service.

It is not uncommon to discover problems during the course of an encounter for preventive medicine. The complexity of the Medical Decision Making (MDM) for the problem or pre-exsisting condition determines if an E/M should be billed in addition to the preventive CPT code.

Significant Problem:
If the problem is significant enough that it requires the performance of key components then the service may be reported in addition to the preventive code. Example: 99213 or 99214

Insignificant Problem:
If the problem or pre-exisiting condition does not warrant significant work or effort it would not be appropriate to report a seperate service.
Example: 99211 or 99212.

In addition a E/M service requires a Chief Compliant, so if there is not a documented cheif complaint the E/M service would not be supported. The refilling of mediciations for established diagnosis would not support billing an E/M service in addition to the preventive service.

Seperate documentation is not required but strongly recomended. Each CPT billed should have it's own documentation to support billing the service.

Hopefully this answers your question. Have a great day.

Allison L. Wickham, CPC, CEMC

 

[LLovett]

I have a problem with the 99211, if the doctor did it and it was significant enough to justify another E/M (which I have no doubt it was) this should be more of a 99212 or 99213.

Just my opinion,

Laura, CPC

 

[pamtienter]

I agree with Laura. The lowest E/M a physician or NPP bills is usually a 99212. A nurse visit would be 99211.

 

[Orthocoderpgu]

Where can I find the Official E/M rules at? And thanks for all of your ideas, very helpful.

 

[mamacase1]

I have an office that seen a patient for an ankle sprain they charge 99213 and they put on a splint and L code then they also billed the 29505 with not other DX on the E & M charge. Can that be done?