Wiki Wellness ,Sick Visit , and Tdap same day

[lenaraamackerjackson@yahoo.com]

Good Morning,
A patient was seen for a wellness visit with an immunization but also had a sick visit all on the same day. I understand that a modifier 25 should be added to the sick visit but I am getting this error in claims management.

901 NCCI: HCPCS 99396 is a Column 2 code and may not be billed with Column 1 HCPCS 90471 on the same date of service. A valid NCCI modifier should be appended to the Column 2 HCPCS if documentation supports medical necessity to separately bill the services.

What modifier should be used for the Wellness visit? Please advise.

Thanks,
Confused Coder

 

[Ccdgea08]

Example: code 99396 90715 90471-59 99214 25// If the insurance is medicare they will only cover tdap if the patient suffered an injury. You will need an injury dx code and use modifier xs instead of 59 for medicare.

 

[lenaraamackerjackson@yahoo.com]

Example: code 99396 90715 90471-59 99214 25// If the insurance is medicare they will only cover tdap if the patient suffered an injury. You will need an injury dx code and use modifier xs instead of 59 for medicare.

Thanks for clarifying that for me !!

 

[nlbarnes]

I've been waiting on some clarification myself but about the level of service that you can bill in addition to a wellness exam. I have an article form AAPC Healthcare Business Monthly that states a problem focused exam (99202/99212) can be billed. Can anyone tell me if this is the ONLY level that can be billed or the level based on documentation/MDM? I can't find anything that specific on the CMS website. If anyone has an answer, can you please provide reference that I can give to my providers?