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Thread: Biller/Coder

  1. #1

    Exclamation Biller/Coder

    AAPC: Back to School
    Good afternoon
    I am tring to obtain any literature to support billing a wellness exam (99397) with a Diagnosis code of V70.0 as well as an E&M (99212) with diagnosis codes 401.1 and 272.0 on the same visit.
    Thank you in advance
    Last edited by RENEE ESPINOZA-ATENCIO; 08-04-2011 at 04:10 PM.

  2. #2
    Join Date
    Apr 2007


    I am not really sure what your asking. Literature to support billing a wellness exam and an E/M? If the physician did, infact, due a preventative visit that day and then went on to do an E/M visit you may bill for it. Of course, you have to meet the criteria in order for you to bill an E/M on the same day as a wellness exam. Maybe be a little more specific with what your looking for and I should be able to help.
    Kimberly Jawidzik, CPC
    MedAssure, LLC
    Physician Billing & Consulting

  3. #3


    I am looking for an article that supports that the codes may be billed together with a modifier of 25. I recall reading it before in one of the coding edge magazines.
    Thank you

  4. #4


    Yes you may bill an E/M on the same day as a physical.

    Code the physical cpt code and point to just the V70.0

    Then point the other diag codes to the OV-E/M make sure that what ever you code (e.g. 99212 or 99213) for the E/M the physicians notes support the level of E/M you are coding.

    I can not see the level of E/M being high unless it was a lengthy face to face apointment.
    You may code for the time spent but the note must state that the physician spent an hour with the patient and half that time was spent counseling the pt.

    I have seen both get paid on the same day with commercial insurance although its very rare.

  5. #5
    Join Date
    Apr 2007
    Albany, NY


    My office bills for both the PE and E/M as long as there is a siginificant amount of work that is done on the new or worsening established problem. We do get paid for both charges by some insurances and others we have to appeal. When we appeal part of our support is that right in the 2011 CPT book it states;
    "If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evalutaion and management service, and if the problem or 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. Modifer 25 should be added to the Office/outpatient code to indicate that a significant, separately identifiable evalutaion and management service was provided by the same physician on the same day as the preventive medicine service."

    If you have the AMA Professional Edition of the 2011 CPT this is on page 33.

    Hope this was helpful.

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