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Coding Question

  1. Default Coding Question
    Clearnace Sale
    When billing for a well physical with a patient who has underlying conditions can I also bill a 99213 in addition to the physical code? If so do I use a modifier?

  2. #2
    Default Well visit with 99213
    Modifier 25. Payment depends on the insurance carrier. Many carriers will only pay one of the visits. Medicare does not pay a well visit unless it is on a patient who just received Medicare. Check with your local Medicare intermediary.

  3. #3
    Columbia, MO
    I say no based on what you have described. A preventive visit includes exam of all pre exisiting conditions and going over treatment and medications. If the the PATIENT complains of a symptomatic issue in additon to the preventive, then you have another separately identifiable examination and could carrier depending have a sick encounter in addition to the preventive.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Overland Park, KS
    I agree here. The CPT guidelines state....Any insignificant or trivial problem/abnormality that is encountered in the process of performing the preventative medicine evaluation and management service and which does not require additional work and the performance of the key components of a problem-oriented E/M service should not be reported.

    If the patient presents for the preventive visit and let's say they have DM. The provider performs the preventative and reviws the patient's DM (i.e. diet and exercise, lab results, etc) and the DM is stable, then there is no medically necessary reason to have the separate E/M with the preventative. The condtion in this case did not require the provider to perform the key components of a separate E/M.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

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