coding prev and problem oriented visit

efuhrmann

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If the documentation supports the coding of a preventive and problem oriented service and the provider has not seen patient in 3 years(nor anyone from the specialty) I am inclined to educate the provider that both services cannot be billed with a new patient code. For example, cannot bill 99386 and 99203-25. Unfortunately, my inclinations are not accepted by the medical community and I am looking for something written and definitive. Thanks.
 

mshay134

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When I researched this, this is what came up:

The question as to how to code a new patient receiving both a preventive service and a problem-based E/M at the initial encounter was asked of the AMA. They responded, in the October 2006 CPT Assistant:

"...if a preventive medicine service and an office or other outpatient service are each provided during the same patient encounter, then it is appropriate to report both E/M services as new patient codes (ie, 99381-99387 and 99201-99205, as appropriate), provided the patient meets the requirements of a new patient based upon the previously noted guidelines.

Again this may have changed, but I don't think so. Remember your -25 modifier
 

TYSON1234

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I would check the insurance companies guidelines because last year, I went to a BCBS billing seminar and they will NOT pay for both the E/M visit and yearly exam on the same day.
 
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