Office Visit and Wellness Exam on same DOS


Best answers
I have a patient that has BCBS and came in to the office for a wellness exam.
I know that a wellness exam and office visit cannot be billed together for BCBS.
If the patient comes in for the wellness and there are abnormal findings, do I code this as an office visit instead of the wellness exam?

Thank you.

Maghan Smith, CPC-A


Duluth, MN
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We do split billing for BCBS all the time. If a patient has a new problem, complaint, or existing condition needs work up this does qualify for an additional office level. I have also found documentation on their website for the patients as I have copied it to patient complaint letters who want to know why they have a copay on an office level thinking the whole entire visit should have been paid as a preventive. Blue cross will deny L4's and L5's but will cover L2's and L3's. If the provider spent significant amount of time dealing with non-preventative issues and bill on time for L4 then an appeal is usually needed and documentation sent. What I have been finding lately also is our coders have used the basic Z00.00 (without abnormal findings) code on those types of claims (split-billing) and it is denied for that as it should be the Z00.xx that identifies routine visit with abnormal findings (sorry, not at my desk to find that code) I found this out with Medica claims and working with a rep.