# BILLING FOR EM, wellness, immunizations and sick office visit on the same day



## SHERRY SCHEXNAYDER (Feb 3, 2014)

Child seen today for a wellness with RN, billed 99392-25- TD on one claim,  patient received immunizations also, billed 90471, 90472 on a separate claim. Nurse felt patient had chest congestion pt was seen by the MD. a chest x-ray and injections were done, billed an office visit of 99212-25 with x-ray ,injections on a separate claim. Should we have used modifier 33 or what is the correct way to bill for all these services performed on the same day.


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## mitchellde (Feb 3, 2014)

An RN cannot perform the wellness visit.  To bill as a 99392 the physician or NP must provide the patient evaluation.  
In My opinion this should be billed as the office visit and immunizations only and since the physician did not perform the wellness it cannot be billed and a 33 cannot be used.


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## SHERRY SCHEXNAYDER (Feb 4, 2014)

In the state of La under the Medicaid program previous known as kidmed a RN can perform a wellness. Was not sure if we could bill all those services on separate claims are on the same one.


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## MarcusM (Feb 4, 2014)

When I ran a pediatric practice, IF the sick visit met modifier 25 qualifications, then I would bill the WCC with the vaccinations under the WCC Dx code, and then bill 99213-25 with the Dx for the sick visit.
See the following article:
According to the AMA, "CPT modifier 33 has been created to allow providers to identify to insurance payers and providers that the service was preventive under the applicable laws, and that patient cost-sharing does not apply. "Keep in mind that services that are inherently preventive do not require the use of modifier 33. -What to do when you are billing an evaluation/management (E/M) service and preventive services for the same visit. When these services are part of an office visit, the visit may not require cost-sharing if the primary reason for the visit is to receive preventive services. Cost-sharing is permitted, however, when the office visit and covered preventive services are billed separately and the primary purpose of the visit is not delivery of the covered preventive services. In other words, when the main reason for the visit is for preventive services, co-pays, coinsurance, or deductibles will not apply.
In these situations, we understand that carriers will define the primary reason for the service by reviewing the CPT codes, modifiers, and ICD-9 codes. So correct order—and linking—of your diagnosis codes will be the key. If the primary reason for the visit was preventive, then the applicable preventive ICD-9 code (for instance, V70.0) would be listed as the primary diagnosis on the claim.
Also remember that, when deciding whether it is applicable to bill an E/M code in addition to a preventive medicine code, the CPT manual specifies that only additional work (the work over and above what normally is performed during a preventive exam) can be counted toward the E/M code level. Therefore, the E/M code level normally is no more than a level 3.
- See more at: http://medicaleconomics.modernmedic...&sk=&date=&
			&pageID=2#sthash.Gz4g7wac.dpuf


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