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Thread: Office Visits & CPE Same Day, 25 mod HELP!!!!

  1. #1

    Exclamation Office Visits & CPE Same Day, 25 mod HELP!!!!

    AAPC: Back to School
    One of our offices likes to bill regular office visits (99212-99214's) and preventatives (99391-99397's) on the same say with a 25 modifier, when patient just came in for CPE, but other issues were discussed.

    Is there a set of guidelines specific to this type of situation as to what would be considered over and beyond the CPE to allow the doctor to bill a separate office visit same day?

    Any guidance would be great!

  2. #2
    Join Date
    Apr 2007
    Greeley, Colorado


    CPT clearly states this in the Preventive Medicine section (pt 29 2009 CPT Professional).
    Lisa Bledsoe, CPC, CPMA

  3. #3


    I know that CPT clearly states this, however it does not state what they consider to be significant enough (above what would already be examined/discussed for a CPE) to bill for the office visit.

    If the doctor does not document a separate note, what would be considered double dipping in the ROS & Exam, since a CPE should be complete/age appropriate ROS and Exam?

    Does the mere mentioning of an issue, example: pt has diabetes, well controlled; warrant a separate visit, when all systems already reviewed as part of the CPE?

    Or Example CC: shoulder pain, then under Exam MSK: Pain on Abduction of left arm, Patient prescribed meds, & patient’s instructions: tendonitis & to see ortho, warrant a 99213 separate visit?

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