Practice Management Alert

Get paid everything you deserve by also billing for an E/M service when a physician treats a distinctly separate problem during a preventive exam. 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 misuse of modifier -25.

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