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Wiki preventive visit and E & M visit

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jbhuju

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hello :)
just a general question, provider can bill preventive visit and E7m on same claim with modifier 25 on E&M code. and there should be appropriate documentation for why extra E & m code was coded right? and do you have any idea if insurance will pay for both codes?
thank you in advance .
 
Yes, a preventive visit and a separate E/M can be billed together if there are new findings and/or there are changes made to an existing conditions. Changes would include increase or decrease in medications for a certain condition or change in DME. The provider should also document any new findings in HPI and exam. You would append a 25 modifier to the separate E/M. Example: 99214-25, 99394. Someone payors will not accept this. From my experience BCN does not want to pay these. I would suggest proposing a billing respond of "Documentation supports two visits, please adjust as needed. "
 
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