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Thread: Medical Clearance and Well Visit

  1. #1
    Join Date
    Apr 2007

    Thumbs down Medical Clearance and Well Visit

    AAPC: Back to School
    I have a doc who is billing a well visit (ie: 99396) AND medical clearance (ie: 99243 private ins.) on the same day.
    I'm saying no way this can be right, 2 E/M's on same day, not to mention using same key components for both codes. It would be double dipping in my opnion, but I need to prove my point and am looking for any guidelines that prove this is wrong.
    Have looked through CPT without any success.
    Any direction you can give me will be greatly appreciated.
    Thanks in advance for your input,

  2. #2
    Join Date
    Apr 2007


    Ok, why are the patients coming in?

    Do I understand correctly when you are saying they are using the same key components that you can not separate the 2 visits out of the note?

    While it is ok to have 2 E/Ms and only have one note, you can not use the same info twice. You have to be able to pull enough info out that supports each code on its own.

    If they are both based on the same info you can not use the 25 modifier, there is one thing you have in writing that should help prove your point.

    I am really perplexed though as to why this would seem ok to anyone to start with. So I would like to see some more info as to why these patients are coming in and what type of provider this is.

    Laura, CPC, CPMA, CEMC

  3. #3
    Join Date
    Apr 2007


    The patient's are coming in for Medical Clearance for surgery to their Primary Care MD.

    For some god awful reason he thinks this is okay. There aren't two notes, only the dictation for the med. clearance. No problems noted, due for a well visit, so bill both! Frustrating!

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