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Routine annual exam with ultrasounds done

  1. #1
    Default Routine annual exam with ultrasounds done
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    I have an issue where pt comes in for an annual exam and complains of pain, so 76700,76770, and 76856 may be ordered. The problem arises when billed out. They are denying the ultra. codes because it was done with an "annual " exam. I have not seen any documentation for the visit, but seems to me it should be coded as an established pt (9921*) e/m rather than an annual e/m (9938*). Any thoughts on this are appreciated.

  2. #2
    Location
    Duluth, Minnesota
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    1,133
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    I'd link the ultrasound to the pain code(s). (not the routine px code). Perhaps the provider felt they didn't do "enough" to justify another E/M level so they wish only to code the preventive code. Follow up for the pain will more than likely be after the results of the ultrasound come back. You should still have the Vcode for the routine px, and pain code(s) for the pain. (link accordingly)
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  3. #3
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    thanks for your input -I will have to see the doc. to clearly know if a prevent vs an established e/m should be billed.

  4. #4
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    Could a prevent and an office visit e/m be billed on same dos if they are done for seperate and distinct reasons?

  5. #5
    Location
    Duluth, Minnesota
    Posts
    1,133
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    yes, but the office visit E/M will need a .25 modifier on it - and both services documentation must "stand alone" and support each service provided separately. Documentation is a key factor when coding two E/M's the same day. Usually, our provides dictate two separate notes when they bill a preventive and an E/M. That really helps support each service!
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

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