# Annaul exam and sick exam



## hland (Mar 7, 2014)

I have another question.  Where I came from before when someone came in for a annual visit (physical, pap or well child) that's all you saw them for.  If they said "oh by the way..." they had to make another appt. Where I'm at know they said that I could use the  modifier 25 and a lower office visit for the "oh by the way..." and a physical code for the annaul.  That doesn't sound right to me because I alway thought that you couldn't be well and sick at the same time.

Thank you for any help.....


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## mitchellde (Mar 7, 2014)

You can for ICD -9 with great documentation.  You must be able,to separately identify the components of the sick visit as distinctly different from those of the preventive without duplication .  However ICD-10 CM code for the general preventive visit does not allow the assignment of signs and symptoms or other reported diagnosis.  There is not way with ICD-10 CM to bill both.


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## hland (Mar 7, 2014)

We have a resdient program so they go beyond the call of duty when it come to documenting in the note   I'm going to a bootcamp in the next week that is a ICD 10 bootcamp so hopefully I can bring back the knowledge to the docs and the people who schedule the appts.


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## akj (Mar 7, 2014)

Where I'm at, we encourage our physician practices to schedule an appointment for the patient to come back for the 'oh, by the way's.  Regardless of how good the documentation is, several of our payers will not pay both services on the same date, regardless of modifier usage.


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## hland (Mar 7, 2014)

Thank you guys...I was thinking the same thing.


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## MarcusM (Mar 7, 2014)

We learned the hard way while freezing warts in a pediatric practice.  This "surgical" procedure overruled our extensive documentation for a well child and a sick visit and Medicaid paid about $18.00 for the entire time spent.
http://www.sccma-mcms.org/Reimburse...ument-preventive-and-sick-visit-properly.aspx

The CPT code book instructs, “If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem or abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate Office/Outpatient code 99201-99215 should also be reported.”Documentation must support both services. If any portion of the history or exam was performed to satisfy the preventive service, that same portion of work may not be used to calculate the additional level of E/M service. A separate history of present illness (HPI), describing the patient’s complaint, supports additional work in the history (there’s no HPI for a preventive service). If a portion of the exam performed is not routine for a preventive service, clearly identify that portion.

Remember: When selecting the additional E/M level of service, only the work “above and beyond” what would have been performed during the preventive service may be counted toward the problem-focused visit.Lastly, when reporting the preventive visit and a problem-focused visit on the same day, you must append modifier 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service to the problem-focused visit code.


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