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preventive E/M with problem-focused E/M

  1. #1
    Cool preventive E/M with problem-focused E/M
    Medical Coding Books
    When there is a problem-focused E/M performed during the same encounter as a preventive/wellness visit, are commercial payers including payment of the problem-focused E/M as part of the 100% wellness benefit mandated by health care reform?

    In other words:

    A) 99385, V70.0, Paid by Plan @ 100% of Allowed Amount and
    99213-25, 466.0, Paid by Plan @ 50% Charge Subject to deductible/coinsurance/copay

    OR

    B) 99385, V70.0, Paid by Plan @ 100% of Allowed Amount and
    99213-25, 466.0, Paid by Plan @ 100% of Allowed Amount

  2. #2
    Default
    [QUOTE=johnny_alley;174515]When there is a problem-focused E/M performed during the same encounter as a preventive/wellness visit, are commercial payers including payment of the problem-focused E/M as part of the 100% wellness benefit mandated by health care reform?

    In other words:

    A) 99385, V70.0, Paid by Plan @ 100% of Allowed Amount and
    99213-25, 466.0, Paid by Plan @ 50% Charge Subject to deductible/coinsurance/copay

    OR

    B) 99385, V70.0, Paid by Plan @ 100% of Allowed Amount and
    99213-25, 466.0, Paid by Plan @ 100% of Allowed Amount[/QUOTE

    To date, I haven't come across scenario #1.

    But it could be at the plans descretion.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  3. #3
    Location
    Columbus, Ohio
    Posts
    77
    Post I have
    I believe it is Aetna or UHC that did it. I've seen it maybe 3x this year. What was the insurance?

  4. #4
    Default
    Quote Originally Posted by stephanie7480 View Post
    I believe it is Aetna or UHC that did it. I've seen it maybe 3x this year. What was the insurance?
    You've seen which scenario? I work for a not-for-profit health insurance company in Wisconsin, and we were wondering how other payers covered these types of claims. Thanks for you input!

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