Ob-Gyn Coding Alert

Question: A patient comes in for her annual, and then the doctor treats a complication appropriate for a level-three E/M visit. He then orders an ultrasound. If we append a modifier to the E/M service, the annual doesn't seem to get paid, and we have to appeal. Is there any reason why we can't use modifier 25 on both lines? Ohio Subscriber Answer: The real issue is whether this payer accepts both a preventive service and a problem-based E/M service on the same date. Although CPT includes a guideline just before the preventive services codes that tells you how and when to bill a problem and preventive service, many payers out there still don't allow this. So if the patient has a major problem on the date of the scheduled annual, you would be better off having the physician address that problem only and then reschedule the annual. 'Good advice: [...]