From a pure coding perspective, the guidelines for billing an E/M service in addition to a preventive service are spelled out under the Preventive Medicine Services section in the CPT 2007 book. The guidelines state; â€śIf an abnormality/ies is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem/abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate Office/Outpatient code 99201-99215 should also be reported.
Modifier 25 should be added to the Office/Outpatient code to indicate that a significant, separately identifiable Evaluation and Management service was provided by the same physician on the same day as the preventive medicine service.â€ť The key to adding an E/M service to a preventive service is the significance of the problem, the amount of work required at that visit to deal with the problem, and how clearly this is documented in the patient chart.
Side note: not all payers follow these rules. You can bill both, but some payers will bundle the services regardless of coding conventions will not overturn on appeal.
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