Wiki Documentation required for billing 99384-99395 with E/M

[susansisson]

I am hoping someone will know where I can find guidelines or documentation on how to bill a preventative CPT 99384-99395 with an E/m if a patient is presenting for their annual well woman visit and also has some other issue going on such as a yeast infection or BV.

Thank you!

 

[Pathos]

This one can be a little tricky. Because payer policies vary greatly on preventative and problem visits, our practice has chosen to either bill one of the two, or focus solely on the one type of visit and have the patient return back for the other type of visit the provider didn't treat.

However, Correct Coding would code out both visits (make sure the right diagnosis go with the right procedure code!), and append Modifier 25 to the E/M problem visit. Some payers might pay this, some might pay a portion of either code and some will flat out deny both services.

Another method is querying the provider on which procedure most of the time was spent on. If 50% or greater was spent on the preventive portion, then bill out the Preventive code, and same with the E/M problem visit. Caution, that the patient will probably be upset when they get a bill for what the patient thought was going to be a "free" checkup (preventive).


Sources:

Making Sense of Preventive Medicine Coding

Same-day Preventive and E/M Services

Coding Preventive Care Services