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Wiki Reimbursement for E/M for Illness at Wellness exam

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KimKrebs

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Anyone else having problems with FULL reimbursement for the OV (99212-99214) when billing it with a wellness exam (99391-99395)? Reimbursement was always @100% as long as it was coded with modifier 25, now we are only being reimbursed 50%.

Thanks!

Kim Krebs,
CPEDC
 
We hadn't had any issues with this previously. It would either pay in full or the OV would be applied to patient deductible if they had one. However, I just had one that was a well exam with abnormal findings and an OV was done due to the abnormal findings. insurance paid the wellness and completely denied the OV completely stating the benefit for the service was included in the payment for another service. This was appealed and they still upheld their denial stating reimbursement is not allowed for the lesser level E/M service code and the provider should select a level of service representative of the combined services and submit the appropriate code for that level.
 
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