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billing/coding physical & sick visit together

  1. #21
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    Exam Training Packages
    Is this stated anywhere else? I can only find this being said on AAPC . Our corporate office states it's just an opinion of the interpretation of the rule and that our drs do not need to follow. They can just keep billing sick and well visits together . They want this stated in writing from a governmental body and /or other coding forums and I can't find anything.
    Me and our other coder agree with AAPC, it seems clear as day sing reading the article in the July magazine
    Thanks.

  2. Default
    There is a follow up article in the September issue that should help you

  3. #23
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    Thank you.

  4. #24
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    There is also an article in the October 12, 2015 Part B News that addresses this. It states you can bill a problem visit on the same day as a well visit.

  5. Default
    Quote Originally Posted by mitchellde View Post
    The exclude 1 note will be the driving factor. You canot code a symptom with a wellness, the directive is to code to the symptoms. An abnormal finding is not the same as a presenting symptom.
    Stable chronic conditions are neither symptoms nor abnormal findings, but you cannot charge a separate visit level to reorder meds for these issues
    You cannot use the two dx codes together on the claim due to the excludes 1. It is a field 21 edit not a field 24 edit. It does not matter how you link them, the edit applies to the listing of the codes on the claim in field 21

    If a patient needs a med check while at their wellness exam, for example for their ADHD meds, is this billable or must they schedule a separate appointment?

  6. Default Coding well checks and med checks
    If a patient needs a med check while at their wellness exam, for example for their ADHD meds, is this billable or must they schedule a separate appointment?

  7. #27
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    Quote Originally Posted by mitchellde View Post
    The exclude 1 note will be the driving factor. You canot code a symptom with a wellness, the directive is to code to the symptoms. An abnormal finding is not the same as a presenting symptom.
    Stable chronic conditions are neither symptoms nor abnormal findings, but you cannot charge a separate visit level to reorder meds for these issues
    You cannot use the two dx codes together on the claim due to the excludes 1. It is a field 21 edit not a field 24 edit. It does not matter how you link them, the edit applies to the listing of the codes on the claim in field 21
    I know I'm late here, but we have providers on both ends of the spectrum so am researching: some state (and are quite adamant) the time and effort it takes to review and manage chronic conditions is 100% separate from an AWV, and some of them say they wouldn't bill the extra E&M because it's encompassed in the wellness visit. So I'm researching the issue myself so we can confidently say to them one or the other. I just have a question about the field 21 and field 24 statement. Since we've been using ICD-10 now for over a year, have you had any issues with this edit being the driving force for a denial? I've been handed these visits to pre-audit but didn't always have them. So I know they were sending well visits with the .00 code and sick E&Ms with the diagnostic codes (not saying they did it right, just stating what was previously done). They would've all appeared on the same claim in box 21. But they've never actually rejected or denied. So I was curious to see if that statement was still applicable.

    For my own peace of mind when auditing, I take into account the fact that the AWV includes a health risk assessment. Within the guidelines for the AWV, they link directly to the CDC's article on what an HRA really is. Pulling pieces of this article, we use the following when explaining to providers why they can't bill their diagnostic E&M for reviewing/managing multiple chronic conditions:

    • Part of the annual wellness visit includes a health risk assessment. The design of this is for primary prevention to avert disease, secondary prevention to detect illness early and intervene, and tertiary prevention to better manage acute and chronic conditions (the risk factor analysis). The AWV aims to prevent onset of disease or to slow the progression and exacerbation of existing illness. It is built with a preventive focus which is in contrast to visits which focus on treating exacerbations or existing diseases. So it is assumed that chronic conditions or illnesses will be reviewed and managed at the wellness visit for this reason, whether you see them for it only once a year or not. If there is an issue with one of these conditions and additional, significant workup was needed, that can be taken into consideration for billing an E&M outside the wellness.

    The naysayers still balk and fight me tooth and nail. Some just let it go. But we would like to have it set in stone to provide the education to our network of physicians so we are all doing it appropriately.
    ____________________________
    Heather Holloman, CPC

  8. Default wellness and sick
    So why not use Z00.01 for wellness visit with abnormal findings and additional codes for the abnormal findings?
    then link the wellness visit to Z00.01 and the 99213-25 to the abnormal findings? ie UTI or Knee effusion?
    we bill like this all the time.
    thanks
    john

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