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Preventative care VS. E/M ....

mabb1211

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Can anyone please tell me whats the correct way to code if a Patient is seen for a Preventative care visit but also has a diagnosis? Do I use the Preventative care CODE or E/M with a modifier or can I bill separely for Preventative care and E/M? Thanks...
 

tag60

Guru
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It depends on what the diagnosis is, whether that problem reflects a "significant and separately identifiable" E/M service that is beyond the usual scope of a preventive visit. If so, per guidelines, you can code both the preventive service and the E/M service with modifier -25. (You will find this information in the guidelines before the preventive codes in your CPT book.) The level of E/M should reflect only that problem/diagnosis and its management and not any of the components of the preventive visit. I'm speaking in broad terms here, not knowing your payer/insurance coverage or the diagnosis you are referring to.
 
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