Well/Physical and E/M

JOGelico

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East Orange
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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
 

S Avara CPC

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Baton Rouge Local Chapter
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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.
 

rfayec

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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.
 

Lisa Bledsoe

True Blue
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Greeley, Colorado
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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.:)
 
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Location
Modesto, CA; Central Valley Chapter
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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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