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Wiki Preventative Exams

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mrolf

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When we have patients that are being seen for an annual exam the providers are billing a new or established visit instead of a preventative visit. The insurance companies are paying these using the V70.0 code. I think they should be billing the preventative codes. Is it acceptable to bill new or established visit codes since the insurance companies are paying for them.
 
mrolf said:
When we have patients that are being seen for an annual exam the providers are billing a new or established visit instead of a preventative visit. The insurance companies are paying these using the V70.0 code. I think they should be billing the preventative codes. Is it acceptable to bill new or established visit codes since the insurance companies are paying for them.
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Preventative codes should be utilized. New/est visits are for problem oriented encounters. Insurances may pay this, but it is still incorrect coding and they could recoop that money once they catch the error. Additionally, they're probably being overpaid.

For example...one of my payers allowables for 99385 is $120.48 the allowable for 99204 is $155.58

I'd think they'd be at risk especially if they aren't billing preventatives at all...eventually it will be caught.
 
the only one that will not pay for preventive care visits is Medicare- they only pay for the welcome to Medicare code G0402 and G0403 within the first 12 months of joining Medicare. pr
 
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