Wiki Well/Physical and E/M

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JOGelico

JOGelico

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Hello Everyone,
If a patient's reason for a visit is for a physical, but the physician discusses lab results, addresses other problems, etc; can a Well Code (99381-99397) and an E/M visit be coded together? Would the E/M code be coded with a modifier 25?

Any help will be appreciated! :eek:
Thanks,
Jessica
 
Absolutely. The CPT states that if an abnormality is encountered or a preexisting problem is addressed in the process of performing a preventive E/M service, and if the problem is significant enough to require additional work to perform the key components of a problem-oriented E/M service, the the appropriate office visit code should also be reported with modifier 25. You should also code and immunizations and/or diagnostic tests performed.
 
Some offices will not do both at the same time due to insurance issues. Some companines will not pay both or make it hard to collect. My GYN office gives a form that states they will not do both services on the same day. If a problem arrises during a PE, it's addressed coded and the PE rescheduled.
So, I'd check with the carrier first.
 
If you are going to report both an E/M and preventive medicine, be sure to follow the guidelines in CPT. The E/M portion must be significant enough to require additional work to perform the key components of a problem-oriented E/M service." And of course it MUST be well documented.:)
 
And.......don't forget that Medicare has specific guidelines that must be followed regarding the billing and cost to the beneficiary when they schedule a preventive and end up with both a preventive and 'sick' visit.

Check with your local Medicare Carrier.

Thanks
Tina
 
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