Wiki Medicare Preventative vs E&M

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JLuz

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I got some good feedback that a physician can bill a preventative code with and E&M under certain circumstances. So if a new doctor is billing 50% of her new patients with a 99386, 99204-25 to Medicare I have a few questions:
-only the 99204-25 is getting paid -why?
-even though it may be legit and she has the documentation is she setting herself up for an audit?
-is there a way to code so that both charges get paid that I am missing?

I appreciate any feedback;)
 
The 99386 is not being paid because Medicare does not cover 99386. They have the "Welcome to Medicare and AWV "G" codes. Also, you cannot bill two "new patient" visits. And third the problem that warranted the E/M during the preventive visit must be significant enough to warrant a work up "above and beyond" this means a different History, exam and MDM.

If the documentation does support billing a separate E/M then it should be billed as 9938x,25 and and 9921x.
 
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