Reader Question: Append Modifier -25 for Medication Change

Question: When an asthma patient comes in for a checkup, should I code a sick visit or preventive medicine services?

Ohio Subscriber

Answer: If the allergist provides preventive medicine services, use 99381-99397. Coding a sick visit (99201-99215) depends on the specific asthma service the patient needs.
 
For example, a patient with controlled asthma uses medication when necessary and requires no medication change. If the patient comes in for a well visit, do not code an office visit in addition to the well visit. But if the patient requires a medication change and the allergist writes a new prescription, bill an office visit code appended with modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service), plus the preventive services visit.
 
Be sure to link the appropriate diagnosis code, such as 493.00 (Asthma; extrinsic asthma; without mention of status asthmaticus or acute exacerbation or unspecified), to the office visit.
 
If a patient whom the allergist sees periodically for asthma episodes comes in for a well visit, a lot of time may be required to evaluate the asthma. Because this is above what you would do during a well visit, bill an office visit also.
 
If a patient comes in for a well visit and is having an asthma attack at the time - a rather unusual circumstance - you might reschedule the well visit and bill an office visit only.
 
- Answers to You Be the Coder and Reader Questions provided by a variety of allergy coding experts, including Cindy Schroeder, CPC, CPC-H, LPN, of Merit Care Health Systems in Fargo, N.D.; and Karen Jernigan, CPC, CMIS, office manager at the Asthma, Allergy, and Immunology Clinic LLC in James Island, S.C.