AAPC - Back to school
Results 1 to 4 of 4

Thread: 99401-99404 Help.

  1. #1
    Join Date
    Apr 2007

    Question 99401-99404 Help.

    AAPC: Back to School
    Can these codes be billed with a preventitive visit and a sick visit (mod 25) on the same day? This MD billed 99396, 99212-25, & 99401. The latter two have a dx of 272.0 with the preventative having the V70.0.
    The way I understand it is that counseling is part of a preventitive visit.
    Thanks all for your time in advance!

  2. #2
    Join Date
    Apr 2007
    Duluth, Minnesota


    in my opinion: (and you didn't post the note so I can't say for certain) - it doesn't appear to have a sick visit - If the patient does have hypercholesterolemia, and it's on going (chronic)... nothing new, I wouldn't call it a "sick" visit and it doesn't justify a extra E/M level to me. Is the patients 272.0 an ongoing issue that is watched by this provider? Does documentation support both services? Can the services "stand alone"? if you score it out does it meet the requirements of a level 2? I've never coded a 99401 with adult preventive visits - only on well child visits - so I don't have any opinion on that sorry...
    In short - yes, the preventive and E/M w/mod can be coded/billed same day IF documentatin supports it.
    could you post the note? (maybe my opinion might change)
    Donna, CPC, CPC-H

  3. #3
    Join Date
    Apr 2007
    north seattle wa


    Physical codes include the prev med counseling component so the 99401 would not be seperately billable.
    99401 is also not billable with an illness or symptom dx code. They are for patients who do NOT have symtptoms or a defined illness.
    Hope this helps with the 99401 question.

  4. #4
    Join Date
    Apr 2007


    Thanks Wendy,
    What I'm seeing is well visits with the patient overweight (not new), elevated cholesterol level (borderline previously), or chronic illnesses (ie: Sarcoidosis). The MD is then billing the 99401 along with the 99395-99397's or billing the preventative along with a sick for the high cholesterol with a mod. and then adding the 99401 also. Didn't think that was correct.

Similar Threads

  1. When to use 99401-99404 codes
    By atomasek in forum E/M
    Replies: 2
    Last Post: 11-10-2013, 07:31 PM
  2. Preventive Counseling=99401-99404
    By veloso in forum E/M
    Replies: 2
    Last Post: 07-18-2012, 06:59 AM
  3. Question cpt 99401-99404 - Is anyone working for a family
    By daniel in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 11-07-2007, 07:34 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.