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Annual exam with O/V

  1. Default Annual exam with O/V
    Medical Coding Books
    My doc bills for an annual exam and then charges an o/v with a 25 mod if the patient is there for a problem. Many insurance companies do not have a a co-pay for the annual but do for the o/v. The ones that do not pay the o/v are putting it to the patient responsibility.
    They are also putting the co-pay to patient responsibilty as well.

    Any advice?

  2. #2
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    Quote Originally Posted by mvance View Post
    My doc bills for an annual exam and then charges an o/v with a 25 mod if the patient is there for a problem. Many insurance companies do not have a a co-pay for the annual but do for the o/v. The ones that do not pay the o/v are putting it to the patient responsibility.
    They are also putting the co-pay to patient responsibilty as well.

    Any advice?
    Make sure you inform the patients up front that if they are evaluated for an additional problem during their routine annual physician, there may be an additional visit charged to their insurance and they may have a balance due from that. If you look at the information in the CPT book right before the preventive codes, there is a very good explanation of this. We had a form the patient's all signed with that information on it when they checked in so they were aware there could be additional charges billed. You will be billing the patient for whatever portion the insurance does not pay.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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