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Well/Physical and E/M

  1. #1
    Default Well/Physical and E/M
    Medical Coding Books
    Hello Everyone,
    If a patient's reason for a visit is for a physical, but the physician discusses lab results, addresses other problems, etc; can a Well Code (99381-99397) and an E/M visit be coded together? Would the E/M code be coded with a modifier 25?

    Any help will be appreciated!

  2. #2
    A Well Code and E/M visit can be coded together; E/M has to have a modifier 25 attached

  3. #3
    Absolutely. The CPT states that if an abnormality is encountered or a preexisting problem is addressed in the process of performing a preventive E/M service, and if the problem is significant enough to require additional work to perform the key components of a problem-oriented E/M service, the the appropriate office visit code should also be reported with modifier 25. You should also code and immunizations and/or diagnostic tests performed.

  4. #4
    Are these the same codes to use for Medicare patients?

  5. #5
    Some offices will not do both at the same time due to insurance issues. Some companines will not pay both or make it hard to collect. My GYN office gives a form that states they will not do both services on the same day. If a problem arrises during a PE, it's addressed coded and the PE rescheduled.
    So, I'd check with the carrier first.

  6. #6
    Greeley, Colorado
    If you are going to report both an E/M and preventive medicine, be sure to follow the guidelines in CPT. The E/M portion must be significant enough to require additional work to perform the key components of a problem-oriented E/M service." And of course it MUST be well documented.

  7. #7
    Default response to well/physican and e/m
    to piggy back off of lisa curtis....please note the dx for the preventative must be different from the dx for the e/m
    Rachele Porter, AS, CPC, CPC-H, CEDC
    no weapons formed against me shall prosper

  8. #8
    Modesto, CA; Central Valley Chapter
    And.......don't forget that Medicare has specific guidelines that must be followed regarding the billing and cost to the beneficiary when they schedule a preventive and end up with both a preventive and 'sick' visit.

    Check with your local Medicare Carrier.


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