Wiki well exam question

[cmac]

5 yr old, new patient, in for well exam and Dr finds heart murmur and hypospadias. would you bill the 99383 with the appropriate E/M (99213 lets say) with 25 mod on the 99213? does carve out apply or would it be normal pricing? if carve out applies how would you put that on a claim?

 

[ARCPC9491]

I would say no - just stick with your 99383. because when you are doing a well exam, you are looking for problems - if you come across them, that's apart of the well visit. that's what your intent was - checking for problems.

Now, if a patient comes in and complains of a sore throat at the time of the well visit, if the documentation supports the other E/M for the sore throat, then okay. Anytime they say, 'oh by the way... this or that is going on..." that's a red flag a seperate E/M may be warranted. The E/M should have a chief complaint- from the patient.

 

[rthames052006]

5 yr old, new patient, in for well exam and Dr finds heart murmur and hypospadias. would you bill the 99383 with the appropriate E/M (99213 lets say) with 25 mod on the 99213? does carve out apply or would it be normal pricing? if carve out applies how would you put that on a claim?[/QU


If an abnormality/ies is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem abnormaility is significant enough to require additional work to perform the key components of a problem-oriented e/m service, then the appropriate office/outpatient code 99201-99215 should also be reported. Modifier 25 should be added to the Office/outpatient code to indicate that a significant, separately identifiable e/m service was provided by the same physician on the same day as the preventive medicine service. The appropriate preventive medicine service is additionally reported.

That was directly from CPT.