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Wellness visit with E/M same day denied

  1. Default Wellness visit with E/M same day denied
    Medical Coding Books
    Is there new guidelines that have been released. We have always been able to bill e.g. (99395, 99213-25). and get paid for both. Now the E/M gets paid but physical denied. Both services not payable on same day.

    Anyone have any insight. This was BCBS. But its also happened with another carrier.

  2. #2
    Location
    Columbia, MO
    Posts
    12,913
    Default
    If the patient has a symptomatic complaint at the time of the preventive then yes for ICD-9 you have been able to code both. However if there is no complaint expressed by the patient then you can bill only the preventive encounter. For ICD-10 CM you cannot submit a prevent and an office visit if the patient presents with a symptom/complaint at the same time as a preventive, symptoms areexcluded from the preventive dx codes andyou are instructed to code only the symptom.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Roanoke, Virginia
    Posts
    125
    Default
    I've not had this trouble recently, Madcoder. When applicable, I've used a preventive code and a modifier 25 on the office visit. Insurance has denied one or the other time to time, but I've always appealed successfully.

    Marlena

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