• 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 your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We’re introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

Office Visits & CPE Same Day, 25 mod HELP!!!!

volleyb13

Networker
Messages
29
Best answers
0
One of our offices likes to bill regular office visits (99212-99214's) and preventatives (99391-99397's) on the same say with a 25 modifier, when patient just came in for CPE, but other issues were discussed.

Is there a set of guidelines specific to this type of situation as to what would be considered over and beyond the CPE to allow the doctor to bill a separate office visit same day?

Any guidance would be great! :confused:
 

volleyb13

Networker
Messages
29
Best answers
0
I know that CPT clearly states this, however it does not state what they consider to be significant enough (above what would already be examined/discussed for a CPE) to bill for the office visit.

If the doctor does not document a separate note, what would be considered double dipping in the ROS & Exam, since a CPE should be complete/age appropriate ROS and Exam?

Does the mere mentioning of an issue, example: pt has diabetes, well controlled; warrant a separate visit, when all systems already reviewed as part of the CPE?

Or Example CC: shoulder pain, then under Exam MSK: Pain on Abduction of left arm, Patient prescribed meds, & patient's instructions: tendonitis & to see ortho, warrant a 99213 separate visit?
 
Top