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Preventive Visits versus Considered "Office Visits"

  1. #1
    Arrow Preventive Visits versus Considered "Office Visits"
    Medical Coding Books
    Our office is having difficulties with defining preventive visits versus office visits to our physicians. It is cut and dry when the only diagnosis code is V70.0 and example 99396 is billed however, some physicians are still charging a 99396 with a V70.0 and hypertension, diabetes or a 99396 with cough, ear pain etc.
    Does anyone have any advice on how to better define to our physicians when a preventive visit is acceptable and the line drawn when a planned preventive visit turns into an office visit?


  2. #2
    Columbia, MO
    A preventive visit can have the other chronic diagnosis listed as well especially when labs or other tests are ordered to check drugs and disease process. This is still a preventive exam. Think of a preventive exam as an annual inventory where you are just checking the status of things, to check the status of underlying conditions that have not changed or have no complaint is still just a preventive. If you are going to convert this into an ov then there has to be a symptomatic issue expressed by the patient that the provider spends more than 50% of the visit addressing. Then this is not a preventive. If the provider wants to split bill then there must still be a symptomatic issue on the patient's part but it is minor in nature and the AMA supports that this should be no more than a level 2 ov. Then you may bill the preventive and a 99212 together with a 25 modifier. As long as you have 2 separate documentations to support the use of the separate ov and the 25 modifier.

    Debra A. Mitchell, MSPH, CPC-H

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