preventive E/M with problem-focused E/M

cmranvik

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When there is a problem-focused E/M performed during the same encounter as a preventive/wellness visit, are commercial payers including payment of the problem-focused E/M as part of the 100% wellness benefit mandated by health care reform?

In other words:

A) 99385, V70.0, Paid by Plan @ 100% of Allowed Amount and
99213-25, 466.0, Paid by Plan @ 50% Charge Subject to deductible/coinsurance/copay

OR

B) 99385, V70.0, Paid by Plan @ 100% of Allowed Amount and
99213-25, 466.0, Paid by Plan @ 100% of Allowed Amount
 

rthames052006

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When there is a problem-focused E/M performed during the same encounter as a preventive/wellness visit, are commercial payers including payment of the problem-focused E/M as part of the 100% wellness benefit mandated by health care reform?

In other words:

A) 99385, V70.0, Paid by Plan @ 100% of Allowed Amount and
99213-25, 466.0, Paid by Plan @ 50% Charge Subject to deductible/coinsurance/copay

OR

B) 99385, V70.0, Paid by Plan @ 100% of Allowed Amount and
99213-25, 466.0, Paid by Plan @ 100% of Allowed Amount[/QUOTE

To date, I haven't come across scenario #1.

But it could be at the plans descretion.
 

cmranvik

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I believe it is Aetna or UHC that did it. I've seen it maybe 3x this year. What was the insurance?
You've seen which scenario? I work for a not-for-profit health insurance company in Wisconsin, and we were wondering how other payers covered these types of claims. Thanks for you input!
 
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