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Wiki Wellness check

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jgosney

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I have a coding question. A 4 month old was seen for a wellness check. The mother was concerned about the baby scalp. The doctor told her it was cradle cap and discussed some remedies. They charged $150 just because of that diagnosis. Wouldn’t that be coved under the Wellness check code? The appointment was in September before the new codes came out. Thank you, Jenny
 
jgosney said:
I have a coding question. A 4 month old was seen for a wellness check. The mother was concerned about the baby scalp. The doctor told her it was cradle cap and discussed some remedies. They charged $150 just because of that diagnosis. Wouldn’t that be coved under the Wellness check code? The appointment was in September before the new codes came out. Thank you, Jenny
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The only way a provider can charge for a wellness E/M & sick visit E/M on the same day is if there is a separate note to support both codes or they document in one note and documentation supports both visits. Not all payers will cover both visits in the same day.
I am not sure what level of service your $150.00 charge is for. Even if the visit was strictly for cradle cap depending on documentation it would most likely be a 99212 possibly a 99213.
 
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