Wiki Horizon NJ Health and Well/Sick Visits

[kfrycpc]

Hello,

We have been getting alot of denials for a a sick visit being billed with a well visit when billed to Horizon NJ Health. They sick visit is billed with sick visit dx codes and the well with well codes. The sick visit is also billed with mod 25. I can't locate a rule that states this is not payable, or not payable as coded. Can anyone help on this?

 

[mitchellde]

For ICD-10 CM you cannot code a symptomatic DX on the same encounter as a well visit. Since you cannot code the dx together you cannot code the encounter codes together.