Wiki dual visit

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it's a catch-22. Coding guidelines state that a preventive and a separate E/M can be performed on the same date as long as the documentation for the E/M supports billing it. The quandary is that most insurances will not pay for both, even if the documentation supports it. (Here in Michigan very few pay)... I advise providers to have the patient be seen on a separate date for the E/M. They don't listen, then they complain that they are giving services away for free. We can't win them all! :D
 
Until ICD-10 CM is implemented in Oct, you can charge for both but only if the patient expresses a symptomatic complaint when they present for the annual preventive. The AMA asserts that when this occurs the visit level cannot exceed a level 2. They content that if the patient requires greater than a level 2 service to attend to a symptomatic issue then the patient is too ill to also provide the necessary elements of the preventive. The documentation must support all of the elements of the preventive which cannot duplicate any of the elements of the symptomatic visit. The visit level will require a 25 modifier for this to be payable. You sequence the V70.- code first listed.
Once Oct 1 2015 arrives with ICD-10 CM this will no longer be possible. If you look at the sub category for the preventive DX code, Z00.0, you will see an excludes 1 note for signs and symptoms. Excludes 1 means it cannot be coded here. So once Oct 1 is here there will no longer be the issue of the dual visit.
 
mitchellde said:
The AMA asserts that when this occurs the visit level cannot exceed a level 2. They content that if the patient requires greater than a level 2 service to attend to a symptomatic issue then the patient is too ill to also provide the necessary elements of the preventive.
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Do you have the actual article or a link to the website where this is mentioned on the AMA website?
 
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