Don't Overlook E/M Services

You can bill preventive exams and E/Ms on the same day using modifier -25

Get paid everything you deserve by also billing for an E/M service when your endocrinologist treats a distinctly separate problem during a preventive exam.
 
Many endocrinology practices see patients with controlled diabetes or thyroid conditions who come back once a year for their wellness exam. These preventive visits take care of routine wellness concerns and make sure the patients' medications are maintained, says Tamiko W. Black, CPC, with the Institute for Endocrinology in Atlanta. If the physician treats another significant problem or illness during the visit, you should be coding for a separate E/M service and appending modifier -25. Our experts recommend that you try these five tips:

1. Have your physicians do the preventive exam and then separately document signs, symptoms, medication, and plan of care for any separate medical problem that comes up during the exam, says Manny Oliverez, practice administrator at Farrell Pediatrics in South Riding, Va. You must have separate documentation to code the medical problem E/M separately.

2. Append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code, not the preventive exam code.

3. Minor concerns (that don't merit a separate exam and history) and existing problems (from past visits) that the physician discusses fall under the basic preventive exam code (99381-99387, 99391-99397), as does the "ordering of appropriate immunization(s) [and] laboratory/diagnostic procedures," according to the 2004 CPT manual.

4. "Be ready to send in the documentation when [insurance companies] deny," Oliverez says. An appeal will be necessary to collect payment most of the time because carriers are extremely wary of modifier -25 misuse.

FYI: The HHS Office of Inspector General placed modifier -25 on its 2004 Work Plan because of concerns over misuse.

5. If your endocrinology practice encounters billing for preventive exams with E/Ms often, create a specific appeal letter template to make it a quick and easy appeal to process.

Important: See sample appeals letter left.

- Published on 2004-03-12