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Thread: Preventive and Established patient same day visit

  1. #1

    Talking Preventive and Established patient same day visit

    AAPC: Back to School
    It is my understanding when billing a preventive visit and an established patient visit with modifier 25 you can not use information from the preventive visit to support the established patient visit, ie "HPI/ROS or components of the Exam".

    If someone disagrees could you provide me with a place to obtain reference documents on this issue?

  2. #2
    Join Date
    Apr 2007


    You are correct. The problem visit must stand alone. It doesn't have to be in a separate note but the same information can not be used to support both services.

    If there is not enough info regarding the problem to support a separate visit on its own, then you shouldn't be billing a problem visit in addition to the preventive.

    Laura, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Greenville, SC


    TI agree. The problem part of the visit must be separately identifiable and require significant work up. It cannot be a minor or trivial problem with no significant work up.

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