• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Illness or wellness visit?

Create Wiki
M

micheleswift

Guest
Messages
9
Location
Arcata, CA
Best answers
0
I have a patient that was seen by a Provider. The cc was establish care. Provider basically did a minimal exam and the visit was an immz and updating. The Provider coded this as a 99202 with a dx of V15.83. I have to send this back to Provider but my question is, this doesn't seem to be an illness visit (99202) but it doesn't seem thorough enough to qualify as a Preventive visit -- but pt was seen by a Provider (probably should have been seen by a nurse) -- (Pt is 13 yo) What would you suggest for the visit and primary dx?

Can I use a 99202 with a V70.0 or V70.3??
 
I am still processing this and similar encounters. I guess you can't use a 99202 if there is no HPI.

So if there is no HPI and the pt was seen by a Provider and yet it wasn't a "thorough" preventive exam, how would you code it? I see Providers want to use V70.0 and an illness (99212-99214) for screening exams or medication management.

I need some feedback on this, thanks!
 
micheleswift said:
I have a patient that was seen by a Provider. The cc was establish care. Provider basically did a minimal exam and the visit was an immz and updating. The Provider coded this as a 99202 with a dx of V15.83. I have to send this back to Provider but my question is, this doesn't seem to be an illness visit (99202) but it doesn't seem thorough enough to qualify as a Preventive visit -- but pt was seen by a Provider (probably should have been seen by a nurse) -- (Pt is 13 yo) What would you suggest for the visit and primary dx?

Can I use a 99202 with a V70.0 or V70.3??
Click to expand...

Use CPT 99384 and diagnosis V20.2. All you need for a preventive visit is an age/sex appropriate history and exam, and documentation of counseling/risk factor reductions that would be necessary for that patient's age (it doesn't need to be anything in particular - it's literally tailored to the patient's needs). The "comprehensive" requirement for the Hx and Exam of preventive E/M's is not measured the same way as a "comprehensive" Hx/Exam for a problem-oriented visit. For a teenage boy, there's no specific criteria defined at all, actually. If you don't have any HPI or MDM, and there's no apparent problems, the visit is more than likely a preventive (routine) exam. A surprising number of doctors don't know to use the codes from the 99381-99397 range for routine visits. In the future, if a problem is addressed during a routine exam and is documented properly, you can bill out 2 E/M's - a preventive and a problem oriented, with a 25 modifier on the problem-oriented code. Hope that helps! ;)
 
You must log in or register to reply here.
Top