Is preventative medicine E&M code appropriate?

Janie751

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Could someone please give me guidance for the following scenario:
I have a patient who thinks we should be billing his visits under preventative medicine because there is no copay with Anthem under his plan.
He is being followed every 6 months with a diagnosis of 600.10. The office visits have been billed as 99213 and the only lab work done is a urinalysis. I do not think this should be billed as preventative medicine since we are following him for a medical problem. I would appreciate any help from someone more experienced in this area.
 

Lisa Bledsoe

True Blue
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You are absolutely correct! His insurance may pay for preventive visits (once a year) but not with 600.10! He's just trying to get out of paying his deductible and copay!
 

Janie751

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Thank you for responding. I thought that was correct, but I wanted to make sure before I give him an explanation.
 
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Hi,

It may also help to mention that the two "exams" are very distinct and involve different diagnostic criteria. They are not interchangable in any way. In addition, there is the frequency limitation with preventive codes/exams that would preclude you from billing this service over and over again for him.

Good Luck to you!
 

Janie751

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Thank you for the explanation, that helped me to understand it better. I am slowly gaining back my confidence for coding. I took the exam in 2005 and was not able to find a coding position until Nov, 2007. I am trying to take advantage of all the free training I can find online to help refresh the information.
 
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