First, read the guidelines in CPT for Preventive Medicine Services. You can code an E/M if the problem is significant enough to require the key components of a problem oriented E/M. You would add modifier -25 to the E/M and use the problem dx. With Medicare, you must subtract the amount of the charge for the E/M from the charge for the preventive code so as not to go over the actual charge of your preventive code.
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