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physicals - can somebody tell me

  1. Default
    Medical Coding Books
    To the question about billing MCare pt's for filling out forms. Yes you can bill the pt, because MCare does not cover this service. But the pt must sign an ABN acknowledging that they have been made aware that MCare will not pay for this service and that they (the pt) are responsible for payment.

    To the question of billing the preventative with a 52 modifier, I am a collector and the rule of thumb is to never give an insurance company a chance to reduce your payment if another code will allow you receive full contracted payment, use modifier 52 only when you absolutely, positively have no other choice. The doctors that I have worked for will usually bill using 99213, because they are not the pediatrician who would give the child their annual physical.

    Roni Jones, CPC

  2. #12
    Columbia, MO
    Also per CR1776 a 52 modifer is never allowed to be used on E&M codes to include the preventive E&M.

    Debra A. Mitchell, MSPH, CPC-H

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