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V20.2

atitus

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Help! I am having a problem convincing a doctor that it is not correct, and in fact contradictory to use a diagnosis of V20.2 as a diagnosis on an acute special needs visit such as 99214. He insists you can just use the chronic condition diagnosis then add V20.2 and the 2nd or 3rd or 4th diagnosis.
 

linwill3

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Why does he want to add the V20.2 code to a 99214 visit? V20.2 is for well exams 99381-99385 or 99391-99395.
 

dmaec

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{{nods}} in agreement and wonder with linwill3 - "why" does the provider want to add a wellness code to an E/M visit? Is the provider doing a physical/preventive service also? It's just simply not needed on the E/M. It might even raise eyebrows somewhere and kick it out of payment.

curious - why does the provider want it on there?

Thanks!
 

atitus

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We have developed a new template for our children w/Special Needs.
Since it is very common when they come in for a Well Child Check that the doctor spends most of the visit discussing thier special needs, writing scripts, reviewing other providers notes, ordering PT & OT. A lot more than you typical WCC. He wants to bill a level 4 or 5 (99214-99215),whichever is appropriate rather than a WCC 99391-99395. Which I told him is acceptable, however he wants to put the diagnosis for thier special needs then put V20.2 as the 3rd or 4th diagnosis. He states to not bill insurance with the V20.2 is not being "transperent" and up front with the insurance. I cannot convince him otherwise. I want to prove to him that I am correct on this.
 

dmaec

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I think what your provider should do is "split bill" if he insists on using the V20.2. Bill out both the preventive and an E/M. The well child components will need to be separated from the "other issues", which will probably bring his E/M level down a notch or two. But, if you check the Vcode table in the ICD-9 - the V20.x codes are 1st Dx Only - with the memo of "generally for use as first listed only but may be used as additional if patient has more than one encounter on one day" .. NOT as 3rd or 4th dx on "one visit". MUST have MORE than one visit in one day if the V20.2 isn't going to be listed first - If the patient has only one visit, then the V20.2 is listed first - Sooooooooo: if he charges both a preventive (link the V20.2 to it) and an E/M with the other dx (and a modifier .25 on the E/M) that will work out. If your provider does decide to split bill, two separate notes would be a VERY good idea because each service must be supported by documentation and the documentation must be able to stand alone in support of each service! Note: patients (or in this case patients parents don't take kindly to "two charges" for one visit), your provider should be aware of that too.
all that being said - my personal opinion is - though the patient is special needs it's STILL their well child visit -I'd be upset as a parent if, just because my child had special needs that needed to be addressed a second charge was billed out OR that a higher cost E/M level is billed out (and I pay an office visit & copay), rather than the preventive service code when my insurance pays 100% for an annual well child visit, especially if the issues are chronic, nothing changing, just reviewing, etc...- after all, each persons annual physical is different, they don't treat us all the same. Most of us do have issues that need to be checked/updated/reviewed when we go in, but it IS still part of the annual physical review.
Check out the CSHCN in your area. (Children with Special Healthcare Needs Services Program).
{that's my opinion on the posted matter}
 

atitus

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dmaec,
Thank you for your response. The doctor previously decided that he did not want to bill for two visits and he aware of the problems with billing and parents in regards to his decisons. I will continue to argue the fact that he needs to bill these visits appropriately for the service he is providing. I will contact the state to get more information. I appreciate your input.
 
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