# Billing a well visit with ADHD follow visit



## buerklej (Sep 24, 2015)

The office is divided on if with the new ICD 10 well visit codes if we can bill a pediatric well child exam and an ADHD follow up on the same visit.  If the patient is scheduled to come to the office for a well child exam and an ADHD medication follow up at the same time is this considered part of the well exam or is it billable as a separate E&M service


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## pamsbill (Sep 27, 2015)

My opinion is you should be able to, if it is supported by the documentation. These well-plus-problem oriented visits have always been tricky from a documentation standpoint. IMO, the routine examination should be thoroughly documented and then the problem-oriented visit should be separately documented and it needs to include the appropriate level HPI, exam and MDM and should be able to stand on its own from an auditing perspective.

In my experience, you will probably have to appeal it because they will deny it the first time around, but if it is documented properly, you can get it paid.


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## mitchellde (Sep 27, 2015)

The ICD-10 CM codes for preventive state General exam WITHOUT complaint, reported or suspected diagnosis.  You cannot report a separate visit when the primary reason for the encounter is preventive.  You can only report the well visit without abnormal findings or with abnormal findings.


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## buerklej (Sep 29, 2015)

Thank you for all your help, it is appreciated.


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