Wiki Preventive Medicine Services

[PBS123]

I am new to dx coding and coding preventive services so I have many questions.

I want to bill 99402 with dx V65.43 (injury prevention) for a 30yr (female) established patient. A second procedure will be done the same day with a different dx.

1. is this the correct dx code?
2. is 99395 required? if so, can I use the same dx? or use V70.0 (no gyn)?
3. if 99395 is require would i bill mod 25?

What is the general rule of thumb for billing preventive medicine services? I work for a provider who says he provides at least 15min of counseling for every visit.

Same scenario New Patient.

1. would I also bill an E&M?
2. therefore, would a mod 25 apply to 99203 and 99385?

Thank you so much for your time and input. If anyone has some in depth knowledge I have lots of more questions

Thanks again,
Annie, cpc-A

 

[missduck]

hope this helps

At first glance...a 99402 requires 30 min of counseling not 15 min. It would have to be a minimum of 30 min to qualify. you do not need to use the 99395 unless you actually did the work for that and your counseling code would have to have a separate identifiable diagnosis.

The counseling part is not a cumulative thing (you cannot add up several visits to make the 30 min), so he would actually have to have in his documentation how long he spent on that particular item in order to bill for that code. Basically it will boil down to the documentation.

Mod -25 is used typically attached to the office visit.

For your new patient, if you have a separate issue besides the preventative medicine code, you would use the EM code. For example, they got a their physical and the patient was treated for hypertension, diabetes, yeast infection (whatever) then you would bill an office visit also with a modifier 25. If nothing was really wrong, or they were not treated you would not do the office visit.

Feel free to message me and I will try to help more...I sure we can learn from each other

 

[charlotte]

I am new to dx coding and coding preventive services so I have many questions.

I want to bill 99402 with dx V65.43 (injury prevention) for a 30yr (female) established patient. A second procedure will be done the same day with a different dx.

1. is this the correct dx code?
2. is 99395 required? if so, can I use the same dx? or use V70.0 (no gyn)?
3. if 99395 is require would i bill mod 25?

What is the general rule of thumb for billing preventive medicine services? I work for a provider who says he provides at least 15min of counseling for every visit.

Same scenario New Patient.

1. would I also bill an E&M?
2. therefore, would a mod 25 apply to 99203 and 99385?

Thank you so much for your time and input. If anyone has some in depth knowledge I have lots of more questions

Thanks again,
Annie, cpc-A

You bill the 99402 when there is only counseling performed. When you read the description of a preventive exam 99395 counseling is included in code. Really, it comes down to what the documentation supports.