Results 1 to 9 of 9

Preventive & E/M on Same Day

  1. Default Preventive & E/M on Same Day
    Exam Training Packages
    We are having some challenges with billing for sick and well visits on the same day, as allowed by CPT. (Particularly for Medicare patients understanding their responsibility for paying Preventive Visit) (e.g., patients come in for an annual check-up, but have problems that need to be addressed, as well.)

    Do your physicians bill for both the well visit and the sick visit; bill for a sick visit only; bill for a well visit and ask patients to return if management of condition can be deferred until later?

    If you do bill for both a well and sick visit, is this your practice for New Patients and Established?

    If both a sick and well visit will be charged, do you inform the patient that they will be getting two charges? If so is the information given verbally, in writing?

    How are you instructing your physicians/providers to document – two separate notes?

    Any help you can give would be most appreciated.

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    First of alll, specifically for Medicare, if you code both a problem oriented visit and a preventive, you MUST carve out the fee. For example, if your fee for 99397 is $200 and your fee for 99213 is $100, then you must subtract 99213 from 99397 so that the total charge is no higher than your fee for 99397. Therefore, your patient is only responsible for $100 for 99397.

    The preferred method is two separate notes, but a good auditor will be able to pull the problem oriented from the preventive.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Default
    Quote Originally Posted by Lisa Curtis View Post
    First of alll, specifically for Medicare, if you code both a problem oriented visit and a preventive, you MUST carve out the fee. For example, if your fee for 99397 is $200 and your fee for 99213 is $100, then you must subtract 99213 from 99397 so that the total charge is no higher than your fee for 99397. Therefore, your patient is only responsible for $100 for 99397.

    The preferred method is two separate notes, but a good auditor will be able to pull the problem oriented from the preventive.
    Actually CMS recommends the "allowed amount" of a sick visit be carved out, not the fee schedule amount. I've asked this question a number of times, and the answer from CMS is "allowed amount" be subtracted from the preventive amount. Remember, you may also carve out a breast/pelvic G0101 code, as well as the Q0091, obtaining & handling pap, if performed. There are documentation requirements for these, so be careful. Good luck!
    Evangelina Frohna, CPC, CEMC

  4. Default
    Medicare and the crave out is not a question the guidelines are published and clear and those are being followed when we bill both. However, it's the other questions we are looking for answers on.

  5. #5
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by efrohna View Post
    Actually CMS recommends the "allowed amount" of a sick visit be carved out, not the fee schedule amount. I've asked this question a number of times, and the answer from CMS is "allowed amount" be subtracted from the preventive amount. Remember, you may also carve out a breast/pelvic G0101 code, as well as the Q0091, obtaining & handling pap, if performed. There are documentation requirements for these, so be careful. Good luck!
    You are correct. I should have stated "allowed" amount.
    Lisa Bledsoe, CPC, CPMA

  6. Default
    We are having some challenges with billing for sick and well visits on the same day, as allowed by CPT. (Particularly for Medicare patients understanding their responsibility for paying Preventive Visit) (e.g., patients come in for an annual check-up, but have problems that need to be addressed, as well.)

    Do your physicians bill for both the well visit and the sick visit; bill for a sick visit only; bill for a well visit and ask patients to return if management of condition can be deferred until later? We bill for both, although I do not see a lot of it happening.

    If you do bill for both a well and sick visit, is this your practice for New Patients and Established? That depends on the situation, but typically these are established patients. We would bill for new if the requirements are met.

    If both a sick and well visit will be charged, do you inform the patient that they will be getting two charges? If so is the information given verbally, in writing? Not that I am aware of, it seems that a lot of Medicare patients are not aware that well visits are not covered in the first place, as we frequently get calls regarding the charges for these even when no sick visit is charged at the same time. So since the prevent is reduced by the sick visit charge, it helps make it easier to swallow (even though the allowed charge for the sick visit doesn't reduce it by much).

    How are you instructing your physicians/providers to document – two separate notes? Our providers use one note, we just audit them and carve out.

    As I said I do not see a lot of this happening. Typically most Medicare patients have 3 chronics that are being addressed (at least in our area) at their visits, so the "well" visit doesn't apply in their case. It seems it is quite unusual to have a Medicare patient with no health issues.

    I hope this helps.

  7. Default
    this dialog is very helpful to the rookies (like me) out here. thanks

  8. Default
    Thank you each for your time and input.

  9. #9
    Location
    Scranton, PA
    Posts
    17
    Default
    Quote Originally Posted by Cheryl Driver View Post
    Medicare and the crave out is not a question the guidelines are published and clear and those are being followed when we bill both. However, it's the other questions we are looking for answers on.
    Cheryl,

    Can you tell me where the guidelines are published on the CMS website or maybe give me the link? I need to provide someone with the source for this guidance.

    Thanks!
    Janice

Similar Threads

  1. Annual Preventive & E/M on the same day
    By Edithcha in forum Billing/Reimbursement
    Replies: 7
    Last Post: 01-28-2017, 01:29 AM
  2. medical E&M with preventive E&M same day
    By PERRAULT in forum E/M
    Replies: 1
    Last Post: 05-29-2012, 02:57 PM
  3. Preventive exam and E&M on same day
    By sknapp56 in forum OB/GYN
    Replies: 3
    Last Post: 07-20-2011, 12:22 PM
  4. Preventive & E/M same day
    By SandraKAdams in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 02-29-2008, 09:25 AM
  5. Preventive & E/M same day - coding scenario
    By SandraKAdams in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 02-29-2008, 09:12 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.