Wiki Coding&billing same day visit

[jayala209]

I'm having trouble with a claim getting paid to commercial ins. This pt came in for routine well child check w/ immunizations and also was seen for a sick visit as well. I've tried billing together on same 1500 using mod25 and splitting up the dx to the 9921X AND 9939X. help on the matter would be greatly appreciated thank you

 

[JacquelynA]

getting pd for sick visit with exam

Hello Frustrated, I feel your pain. Here is the solution; First post the well child exam, do NOT put the mod 25 on the physical save it for the E/M. Make sure that you use the correct V code for the physical and that you use the correct AGE specific physical code. Next code the E/M using the modifier 25 and the CORRECT illness icd-9 code. You should code only a level 2 or 3 at the most because the E/M is not as significant when coded with a physical. NOTE; some comm insurances will not pay for E/M on the same day unless you appeal and send documentation.

 

[JacquelynA]

Immunizations on same day

OOPS! I didn't mention the immunizations. Code them last and make sure that you match the correct V code to the J code for the medication and to the injection code. Be careful, I worked for a doctor that would try to charge for two injections when he did a combination shot of two meds in one syringe. One stick, one injection charge. There are also V codes for combination injections so read them all. I like to go to the V code section on vaccines and write in the cpt codes for the injection and the medication codes so that I have a quick reference for all the injections in one place.

 

[jayala209]

Hello Frustrated, I feel your pain. Here is the solution; First post the well child exam, do NOT put the mod 25 on the physical save it for the E/M. Make sure that you use the correct V code for the physical and that you use the correct AGE specific physical code. Next code the E/M using the modifier 25 and the CORRECT illness icd-9 code. You should code only a level 2 or 3 at the most because the E/M is not as significant when coded with a physical. NOTE; some comm insurances will not pay for E/M on the same day unless you appeal and send documentation.

Thank you so much this was very helpful. Appreciate the info

 

[jayala209]

OOPS! I didn't mention the immunizations. Code them last and make sure that you match the correct V code to the J code for the medication and to the injection code. Be careful, I worked for a doctor that would try to charge for two injections when he did a combination shot of two meds in one syringe. One stick, one injection charge. There are also V codes for combination injections so read them all. I like to go to the V code section on vaccines and write in the cpt codes for the injection and the medication codes so that I have a quick reference for all the injections in one place.

Okay so in this situation I would'nt use a V20.2 for the exam? Just the v codes for each inj Exp:90670=V03.82? & what if vacs were up to date and only an exam was performed? what v code would be used then?