Wiki Preventive code

[vaccao]

Hello,
I am a little confused with preventive/E/M codes.

For example, if pt. came for annual physical exam and complains about cold and HTN (which were addressed on this visit with RX) but physical was done also. Can I use both preventive code and E/M code at the same time in this case? I just want to make sure.
Thank you.

 

[Mayzoo]

Page 36 of the 2018 CPT by AMA states:

If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem or abnormality is significant enough to require additional work to perform the key components of a problem oriented E/M service, the the appropriate office/outpatient code 99201-99215 should also be reported. Modifier 25 should be added to the office/outpatient code to indicate that a significant, separately identifiable evaluation and management service was provided on the same day as the preventative service."

 

[mitchellde]

Hello,
I am a little confused with preventive/E/M codes.

For example, if pt. came for annual physical exam and complains about cold and HTN (which were addressed on this visit with RX) but physical was done also. Can I use both preventive code and E/M code at the same time in this case? I just want to make sure.
Thank you.

if the patient presents with symptomatic complaints then you cannot perform a preventive encounter. a presenting symptom is not an abnormal finding. The codes state encounter for general exam WITHOUT complaint, suspected, or reported diagnosis.
the excludes 1 note indicates these cannot by coded with encounter for signs and symptoms, you are instructed to code to the symptoms. this means you defer the annual to a future encounter.

 

[LuckyLily]

What happens then when the patient does present for preventative exam and they are having symptoms or a preexisting condition that are addressed at the same time. Wouldn't those be coded with a 99201-99215 w/mod -25 in addition to the preventative code?

Mitchellde, I've read several other posts that you have posted. I understand that the Z00 codes state Encounter for general examination w/o complaint, suspected or reported diagnosis. If preventative exams are for healthy populations then how are the "abnormal findings" defined as. Is it only the codes in the range of R70-R94 that is stated at the very beginning of the chapter 21 description? Would an 'abnormal finding' be something that the patient is totally unaware of and the medical professional discovers it at that appointment?

I would love feedback. It's one of the best ways to learn. Thanks.