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Illness or wellness visit?

  1. #1
    Default Illness or wellness visit?
    Medical Coding Books
    I have a patient that was seen by a Provider. The cc was establish care. Provider basically did a minimal exam and the visit was an immz and updating. The Provider coded this as a 99202 with a dx of V15.83. I have to send this back to Provider but my question is, this doesn't seem to be an illness visit (99202) but it doesn't seem thorough enough to qualify as a Preventive visit -- but pt was seen by a Provider (probably should have been seen by a nurse) -- (Pt is 13 yo) What would you suggest for the visit and primary dx?

    Can I use a 99202 with a V70.0 or V70.3??

  2. #2
    Default
    I am still processing this and similar encounters. I guess you can't use a 99202 if there is no HPI.

    So if there is no HPI and the pt was seen by a Provider and yet it wasn't a "thorough" preventive exam, how would you code it? I see Providers want to use V70.0 and an illness (99212-99214) for screening exams or medication management.

    I need some feedback on this, thanks!

  3. #3
    Default
    Quote Originally Posted by micheleswift View Post
    I have a patient that was seen by a Provider. The cc was establish care. Provider basically did a minimal exam and the visit was an immz and updating. The Provider coded this as a 99202 with a dx of V15.83. I have to send this back to Provider but my question is, this doesn't seem to be an illness visit (99202) but it doesn't seem thorough enough to qualify as a Preventive visit -- but pt was seen by a Provider (probably should have been seen by a nurse) -- (Pt is 13 yo) What would you suggest for the visit and primary dx?

    Can I use a 99202 with a V70.0 or V70.3??
    Use CPT 99384 and diagnosis V20.2. All you need for a preventive visit is an age/sex appropriate history and exam, and documentation of counseling/risk factor reductions that would be necessary for that patient's age (it doesn't need to be anything in particular - it's literally tailored to the patient's needs). The "comprehensive" requirement for the Hx and Exam of preventive E/M's is not measured the same way as a "comprehensive" Hx/Exam for a problem-oriented visit. For a teenage boy, there's no specific criteria defined at all, actually. If you don't have any HPI or MDM, and there's no apparent problems, the visit is more than likely a preventive (routine) exam. A surprising number of doctors don't know to use the codes from the 99381-99397 range for routine visits. In the future, if a problem is addressed during a routine exam and is documented properly, you can bill out 2 E/M's - a preventive and a problem oriented, with a 25 modifier on the problem-oriented code. Hope that helps!

  4. #4
    Default
    Yes, thank you so much, Brandi.

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