Wiki COnfused well visit w problem

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Coder708

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Hello,

I am very confused on coding a well visit w/ a problem.

For example: pt comes in for 7 year physical doc hits all preventative issues, exam,counseling etc. On same note in exam says head itch.
Assesment and plan says WELL but also doc gave script for lice.
Do I do 99393 & E&M

another example.
two month physical everything is covered for preventative.. IN same note on physical exam states white blisters on tongue. Doc assesment and plan says well and he gave a script.

Some people are saying these are straight 99214's others are saying preventative and 99212..I am so confused.
Any help would be appreciated
 
Coder708 said:
Hello,

I am very confused on coding a well visit w/ a problem.

For example: pt comes in for 7 year physical doc hits all preventative issues, exam,counseling etc. On same note in exam says head itch.
Assesment and plan says WELL but also doc gave script for lice.
Do I do 99393 & E&M

another example.
two month physical everything is covered for preventative.. IN same note on physical exam states white blisters on tongue. Doc assesment and plan says well and he gave a script.

Some people are saying these are straight 99214's others are saying preventative and 99212..I am so confused.
Any help would be appreciated
Click to expand...

I am quoting from the CPT book....

Under Preventive Medicine Services

" If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem or abnormality is significant enough to require additional work to perform the key components of a problem-oriented e/m service, then the appropriate Office/Outpatient code 99201-99215 should also be reported. Modifier 25 should be added to the Office/outpatient code to indiciate that significant, separately identifiable e/m service was provided by the same physician on the same day as the preventive medicine service. The appropriate preventive medicine service is additionally reported."

"An insignificant or trivial problem/abnormality that is encountered in the process of performing the preventive medicine evaluation and management service and which does not require additional work and the performance of the key components of a problem -oriented e/m service should not be reported."

Hope this helps!
 
Preventive and Problem Visit

Hello,
The information posted by rthames052006, is exactly what I have been taught. Just remember even though there may be problem (acute or chronic illness) documented during the preventive visit, there must be additional work performed and documented by the provider. Example: Additional notes in CC: HPI: ROS: EXAM: Impression: and Plan: regarding these problems or established illnesses that are being addressed during this time.
If something is mentioned but no additional work is performed then only bill the preventive code. This is where so many providers and coders fail because the lack of required documentation to bill for both services (Preventive & E/M).
KSS,CPC,Audit Specialist
 
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