Wiki Comprehensive E&M

Medina, TN
Best answers
I am new to using the comprehensive E&M's and have a few questions. Firstly, when a patient comes to our office (Family Practice) for an annual exam they receive their physical (99391-99397), EKG (93000) and a Urinalysis (81003) this is the norm for us and we generally bill with dx V70.0 sometimes if it is pap exam we use V72.31. If something additional is done say an OMT should I code this with the dx V70.0 as well as the SOMAT dx so that no co-pay is applied?

Also, I was reading the guidelines and it states that "if an abnormality is encountered and addressed in the process of performing this preventive medicine E&M service and if the problem is significant enough to require additional work to perform the key components of a problem-oriented E&M, then an outpatient code should be reported as well with the -25 modifier." So if I see a patient for her annual visit, run the usual blood tests and she complains about her wrist hurting thinks that she sprained it. The wrist is examined and an x-ray is done, should I add a 99212-25 with the 73100 and a dx for sprained wrist?

Also with these additional codes would the V70.0 be appended to them as well?
Sorry just one more, does the dx V70.0 have to be on all the lines of the comprehensive exam in order for the insurance to not apply a co-pay? And does it have to be the only dx or can there be others?

Sorry for so many questions but I appreciate everyone who provides input! :)
Last edited: