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e/m billed with well care

  1. #1
    Default e/m billed with well care
    Medical Coding Books
    Our doctors are very good at billing an e/m service along with the well care if it takes alot of additional time. My question is this - if a child comes in for the PE and complains of a sore throat - most will typically bill the e/m code of 99213 with the pe code along with the rapid and agar test. I have one physician that believes that she should reduce the e/m code to a 99212 because it was billed with the PE. I hope this makes sense - but if anyone could let me know if this reduced charge is correct or if all the documentation is there for the e/m code and supports level 3 then would it be correct.

  2. #2
    Wink
    If the documentation supports a level 3 then this is correct. Our docs do this alot. You have to ensure the documentation is there, but also alot of insurance like to see it as a seperate note as well. (one for the wcc and one for the sore throat.) hope this helps!!

  3. #3
    Smile
    Quote Originally Posted by ahp-tvh View Post
    Our doctors are very good at billing an e/m service along with the well care if it takes alot of additional time. My question is this - if a child comes in for the PE and complains of a sore throat - most will typically bill the e/m code of 99213 with the pe code along with the rapid and agar test. I have one physician that believes that she should reduce the e/m code to a 99212 because it was billed with the PE. I hope this makes sense - but if anyone could let me know if this reduced charge is correct or if all the documentation is there for the e/m code and supports level 3 then would it be correct.

    Make sure that you are using modifier 25 on e/m code...
    Yolanda T. Haskins CPC, CRC, OHCC, AAPC Fellow
    Past AAPCCA Board of Directors 2014 - 2017


    Alexandria, VA Chapter

    ~ Practice Kindness ~

  4. #4
    Default
    You can bill the physical and an E/M code if both are documented correctly. We used to use a physical form that was completely seperate from the office notes to make sure documentation is supported. You should code whatever E/M is supported by the doctors documentation. If the physician is documenting at least 2 of the 3 components for a 99213 along with the Physical you should code the 99213. Make sure you use a modifier 25 on the E/M and link your diagnoses correctly using the V code for the physical and the illness code(s) with the E/M.

  5. Default
    Is this for all insurance companies or just certain ones? I work at a practice in NC and we have alot of Medicaid patients. We were told we could not code a healthy visit and a sick visit. Is this true? If not can someone tell me how to do it. Will the first visit get paid and the second be denied then you have to send in medical records and resubmit for the second office visit??

    Hollie Garrett, CPC

  6. #6
    Default
    Quote Originally Posted by hgarrett113 View Post
    Is this for all insurance companies or just certain ones? I work at a practice in NC and we have alot of Medicaid patients. We were told we could not code a healthy visit and a sick visit. Is this true? If not can someone tell me how to do it. Will the first visit get paid and the second be denied then you have to send in medical records and resubmit for the second office visit??

    Hollie Garrett, CPC
    Hollie,
    Oklahoma Medicaid will not allow a sick vist and a preventive visit to be billed together on the same day either.
    Last edited by TammyFarris; 05-29-2009 at 07:18 AM. Reason: typo

  7. #7
    Default
    Several years ago I went to a training for Medicare Part B in New England and they taught that in order to bill a well visit with a component of a sick visit, you must use only the part of the documentation that reflects the sick visit in order to arrive at a code for that. (Well-visits are not covered, but the part that is to treat a problem would be.) The point is that you need to "filter" the documentation to see which code is supported for the sick visit (unless you have separate notes).

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