Wiki Question re: E&M

[tillba18]

I was wondering if a patient comes into the office for a routine Well Woman exam and a problem, can we bill 99395 as well as 99213? And if so, will re-embursement be at a reduced rate?

 

[Lisa Bledsoe]

First, read the guidelines in CPT for Preventive Medicine Services. You can code an E/M if the problem is significant enough to require the key components of a problem oriented E/M. You would add modifier -25 to the E/M and use the problem dx. With Medicare, you must subtract the amount of the charge for the E/M from the charge for the preventive code so as not to go over the actual charge of your preventive code.