# 99215 w/ 99395 Confused pls help



## bill2doc (Sep 19, 2012)

Can you bill 99215 w/ 99395 or is it one or the other?  Bill sheet reads:

99215, 99395, 94760 - DX: Reflus 530.81, Asthma 493.90, Obesity 278.01, Pre DM ??

Can you please clear us these CPT codes.  Seems odd......Thanks


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## blondie11hay (Sep 19, 2012)

Was there a preventive diagnosis code used, V70.0? In order to bill for both the patient would had to have been seen for both a preventive exam as well as a comprehensive established visit or documented in time by at least 50% of 40 minutes spent face to face with patient above and beyond the normal preventive exam visit.


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## mitchellde (Sep 20, 2012)

you can bill an OV with a preventive only if the patient complains of a symptomatic issue at the time of presentation for the preventive.  If the patient is sick enough to warrent a 99215 for the symptomatic issues then there is no way to also perform the elements of a wellness exam as the patient is clearly not well.  If you are using the 99215 due to the patients chronic diagnoses this is incorrect.  The prevent exam includes going over all pre existing/chronic issues.  The AMA several years back published an article regarding this practice and stated that when a split visit is charged the OV portion cannot exceed a 99212, as a person presenting for a preventive/wellness exam cannot be overwhelmingly sick as to exceed a 99212.


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## sumeet_lawhare@yahoo.com (Sep 20, 2012)

*.*

it is really impossible to get 99215 if a chart is qulifying for preventive. if we encounter any problem during preventive services, only the element related to that problem are use to calculate the out patient service EnM code. so it cant go to 99215.


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## Albury17 (Jan 22, 2014)

*Additional clarification*

We have an ongoing discussion about the Preventive Care visit on the commercial insurance and then when the patient comes to their appointments they are always wanting to be seen for a sick visit.  We have been advised that we bill both the prevenetive care visit (99391-99396) along with the sick visit (99212-99215) and to add a modifier 50 to the sick visit coding.  They stated that the insurance will deny the preventivie visit but then we have to appeal the decision.  Is this correct?


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## nc_coder (Jan 24, 2014)

*What I have been looking for!!!*

"The AMA several years back published an article regarding this practice and stated that when a split visit is charged the OV portion cannot exceed a 99212, as a person presenting for a preventive/wellness exam cannot be overwhelmingly sick as to exceed a 99212"
Debra,
Do you remember when this article was published or what it was titled???!!!  I have been fighting this issue for so long and so hard, I am ready to leave the practice I work for now.
I would love to have something from the AMA backing me up.  I have googled this situation so many times it is crazy!


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## mitchellde (Jan 24, 2014)

It was back in about 2004 as I recall it was on their website under coding, they have rearranged this website several times but I suggest you start there.  I do not remember the title.  I saved it to an older computer that has since lost its mind and the data not retrievable.


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## sujit.more (Jan 28, 2014)

*99215 w/ 99395*

Hi All,

to code preventive medicine, we need to have CHIEF COMPLAINT for preventive medicine. e.g. pt here for ANNUAL PHYSICAL EXAM, SPORT MEDICINE, ESTABLISHING CARE, ROUTINE EXAM, COMPLETE EXAM, GENERAL EXAM, WELL WOMAN EXAM, WELL CHILD EXAM, etc.

so as to qualify for preventive medicine chart should have CHIEF COMPLAINT, PFSH,  comprehensive ROS and PE and COUNSELING. if chart having all these factors then we can code for preventive medicine.

if any of these factors missing, then chart do not qualify preventive medicine. and we should code for other problems if any.

if pt is coming for both i.e. say ANNUAL PHYSICIAL EXAM along with other complaints and chart qualifies for preventive medicine too. then we can code PREVENTIVE along with Other problems too. but in this case we should consider only related bullets/systems for problems. 
so in such cases level may not go to 99215, as we will consider only related bullets/systems.


Hope this is helpful.

Thanks

Sujit More, CPC


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