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New prevent and problem visit

  1. #1
    Fort Wayne In
    Talking New prevent and problem visit
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    Patient comes in for a scheduled prevent (9938X); provider also does a problem visit. Are they both coded as new or is the prevent new and the problem visit established?

    thank you



  2. Default
    A new visit is only when the patient visits the same provider or within the same specialty after an interval if three years. Because it is a scheduled visit, hence both the codes i.e. preventive and sick visit will be for established patient with 25 modifier to be appended with the sick visit.
    To verify 25 modifier, records should clearly document the visit over and above preventive visit.

  3. #3
    Coding wise, I agree with the above poster. Look and see how the visit was scheduled. Was the intention to provide an annual preventive visit (which is covered for free with most insurances), or was the intention to have a sick problem visit and then the patient wanted their preventive benefit tacked on.

    In my experience however, most insurances don't accept both services performed on the same day. I educate our providers to choose which service they want to provide that day, or only bill for the service they spent +50% of the time on. Alternatively, the provider could reschedule the sick visit and have the patient return on a later date.

    If the provider does move forward with billing both types of visits, then the patient should at the very least be informed that there might be a bill coming to them for the sick visit part. The problem sick portion is not a covered preventive benefit on most insurances.
    You might end up in an upset patient either way; the patient might get mad over a bill for a visit they thought would be free (if the provider didn't tell him/her), or the patient might get disgruntled over having to come back on a different day for the preventive/sick visit.

    Good luck!
    "When you have exhausted all possibilities, remember this: You haven't!"
    -Thomas Edison

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