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problem visit with prevent med

  1. #1
    Default problem visit with prevent med
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    Hi everyone:

    We are of the thinking that a "problem visit" (99201-99215) should not be billed out along with a prevent med code (99381-99397) unless it is a new, acute problem that requires significant, additional work.

    However, I have a family practice physician that spends a lot of time (1+ hours) on things like obesity, asthma, depression, etc.

    Is there any way to capture this time spent? Would it be appropriate to charge a 9921x (depending upon time documentation) for these chronic/risk prevention concerns?

    Thanks for any input

  2. #2
    Our physicians do code extra E&M services when they provide counseling above and beyond the scope of the normal well child exam. For example, let's say a 10-year old comes in for a well check, and the physician performs all the necessary components of the well child exam, but then the mom starts talking about the child's behavior, the doctor gives the mom vanderbilt assessments to fill out, and they spend an extra 45 mins talking about the child's behavior. We would bill this visit with the well check code as well as the extra office visit code, because it is well outside the scope of the regular well child exam.

    The same goes for asthma, depression, even acne. If the doctor performs a significantly different service, which is separately identifiable from the well check , it is billable as an extra service.

    I have never had payers give me a problem with claims like this, as long as you bill the extra OV with mod-25.

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