Question Preventive and same day sick visit


Best answers
A medically supported reason for an E&M ("sick") visit such as labs, medication changes or refills for a chronic or acute condition with a History of Present Illness/Chief Complaint (such as "diabetes check-up" or "ear pain") unrelated to "wellness" or "preventive".

The ROS for the wellness has to have at least 10, but the E&M does not necessarily need any.

The physical exam should be able to be "separated" (even if it is only mentally separated between affected "sick" systems and "normal" findings) between the two visit types. Otherwise, the provider can list two physical exam sections (if your system supports this) or could add it in text if SOAP noting.

The primary diagnosis should be the "Z00" code, but it would only be linked to the wellness. The secondary diagnosis on the claim form should be linked to the E&M only. Also, add modifier 25 to the E&M code.