Wiki Traditional Preventive with 99214

[ivygirl18@hotmail.com]

Hello,

Any help would be appreciated. This is a debate within my practice and I am cannot find anything that explicitly states it can or cannot be done!


When you do a traditional preventive visit (99395, 99396, etc) and do an e/m visit with it--do you ever bill a 99214?
My thoughts-- is it should not be done because the documentation overlap between the history and exam areas. Since you can only use the documentation towards one service and not for both, this would make it inappropriate to bill these two services together.

 

[Pathos]

I would be cautious to make such a black/white ruling. Correct coding can certainly allow for a traditional preventive visit (also AWVs) to include a regular E/M (992x1-992x5) for the same date of service. However, as you are correctly stating documentation will have to support both codes, and without any overlap (double dipping). If medical necessity allows for a 99214 (and perhaps even 99215 in certain situations), then those codes should be billed.

Commonly, I would probably see more lower E/Ms than higher, due to the nature of the traditional preventive visit, however if the History, Exam and/or Medical Decision Making fully support a significant and separate problem, then you as a coder has the obligation to report this code to insurance. Anything less would be downcoding the visit.

I do mention this every time I discuss this topic, that if you are going to bill an E/M together with a preventive visit; please give the patient a heads up. Educate your providers to tell their patients, that their preventive visit might now include a bill and a copay for the problem focused part. At my previous practice, one of our providers tried to bill E/Ms when they found out they couldn't bill the scheduled AWV (visit was too soon). Needless to say, those patients were none too happy! Same thing happened to patients who thought they came in for a "free" preventive visit, and now got stuck with a bill for a 99213/99214 benefit charge. Alerting the patient is not just good customer service, it's good business practice. Give the patients a chance to understand they might get billed for the problem focused portion, or reschedule for their problem instead. Most patients I know, don't like surprises that end in getting a bill.

Hope this helps!