Wiki New patient for annual exam with sick visit

[STEPHANIE SUDHOLT]

We had a 30 year-old woman who came in for an annual well woman exam who also had severe menomenorrhagia that necessitated further testing and also qualified for a sick visit. My level of service for the sick portion of the visit would be either 99202 or 99213. If I am coding 99385 for the well visit, wouldn't I use the established code 99213-5 for the sick portion of the visit?

 

[missduck]

we bill new pt physical and established pt sick visit (with mod 25)

 

[Saedron]

We had a 30 year-old woman who came in for an annual well woman exam who also had severe menomenorrhagia that necessitated further testing and also qualified for a sick visit. My level of service for the sick portion of the visit would be either 99202 or 99213. If I am coding 99385 for the well visit, wouldn't I use the established code 99213-5 for the sick portion of the visit?

If the patient is new you cannot bill an established code - either of them. Also, for a new patient physical there won't be much left to qualify a new patient E/M visit, because you cannot double dip to qualify both notes. For example, if you gather all the relative past, family, and social history for the new patient physical, you cannot use that information to qualify any level of E/M.

If your E/M level ends up being a 99201 or 99202, I'd consider that incidental to physical. Many carriers do not feel a level 1 or 2 visit is 'significant' enough to warrant a 25 modifier.

Just my .02!