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99392 & 99212

  1. #1
    Talking 99392 & 99212
    Medical Coding Books
    Sorry has been a while since I actually had to "code" code. One of our billing specialists has come to me a peds question:

    "...included cpt 99392 in with 99212, I had appealed this as there was enough evidence to support both charges. They are still denying this cpt as the documents do not support this service because it indicates a problem visit. Any idea why?"

    I was figuring the 99392 should've been billed & no need to address the problem-focused visit 99212 since it was addressed during the preventative.


  2. Default
    did you have a -25 mod on the 99212?

  3. #3
    Don't know... will ask the biller.

  4. #4
    East Stroudsburg, PA
    Also, does the preventative have the V code for the diagnosis? The 99212 should be coded with the problem as the diagnosis code and the preventative should have the V code for the exam.

    It is possible to bill both codes. Also the insurance company may need a modifier of 25 on the 99212.
    ~Rebecca, CPC, COSC, CPC-I

    "To the world you may be one person, but to one person you may be the world" ~Anonymous

  5. #5
    Ok ladies,

    Biller informs me that: yes, V20.0 attached to the preventative 99392 & modifier-25 attached to the 99212.

    I have reviewed the transcription & covers both the physical exam & acute problem.


  6. #6
    Columbia, MO
    Most payers will not tell you but will expect to see two visit notes one which address the preventative only and one which addresses the ov. In many EMRs you will need to close out one note and open another. Since essentially you are billing for two office visits the expectation is that the medical record will show two office notes. If the problem is addressed in the context of the preventive note then they have no motivation to recognise that the office visit is "significant and separately identifiable". Just the reason for denial that you cited leads me to think this may be the issue.

  7. #7
    Thank you, ladies, for your input. My biller has been informed.

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