Wiki E/M Visit vs. Wellness Visit

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neecen

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Good day to All!

I have a provider who is asking when an E/M visit turns into an AWV. I have been pondering this for a couple of days and can't think of any reason or instance this would happen. I have had instances where an AWV turned into an E/M and we explained to the patient(s) why this visit may entail a co-pay and/or deductible.

Thoughts?

TIA

Denise
 
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I have seen an E/M turn into an AWV.

pt comes in for a scheduled follow-up and the MA or provider realizes that they are overdue for their AWV and then performs (and documents) and AWV.

as long as the documentation supports the visit and it is not being done too early, the AWV can be billed.
 
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When a problem oriented E/M and preventive E/M are performed on the same day (whether planned or unplanned), here's my recommendation:
Take the note and cross out everything related to the preventive E/M. That leaves you with the "separately identifiable" portion. Is that information significant? If yes, bill both services. Mod -25 on 99202-99215 for problem oriented. 99381-99397 for preventive. Link your diagnoses accordingly.
If the amount left after crossing out is not significant, then just 99381-99397.
 
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csperoni said:
When a problem oriented E/M and preventive E/M are performed on the same day (whether planned or unplanned), here's my recommendation:
Take the note and cross out everything related to the preventive E/M. That leaves you with the "separately identifiable" portion. Is that information significant? If yes, bill both services. Mod -25 on 99202-99215 for problem oriented. 99381-99397 for preventive. Link your diagnoses accordingly.
If the amount left after crossing out is not significant, then just 99381-99397.
Click to expand...
This is the best advice!

Also check payer rules, some payers say you have to report it on a separate claim and not on the same claim as the preventive. Link your diagnoses correctly like Christine said.

This happens all the time in peds.
 
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csperoni said:
When a problem oriented E/M and preventive E/M are performed on the same day (whether planned or unplanned), here's my recommendation:
Take the note and cross out everything related to the preventive E/M. That leaves you with the "separately identifiable" portion. Is that information significant? If yes, bill both services. Mod -25 on 99202-99215 for problem oriented. 99381-99397 for preventive. Link your diagnoses accordingly.
If the amount left after crossing out is not significant, then just 99381-99397.
Click to expand...
Thank you so much! This makes total sense.
 
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