Practice Management Alert

Question: My office saw a patient for a regular preventive visit but discovered an issue in the midst of the visit. Do we need to report the abnormality?

Texas Subscriber

Answer: This is a common problem coders make when billing 99381-99396.

“An insignificant or trivial illness, abnormality, or problem encountered in the process of performing the preventive medicine service should not be reported separately,” Donna Walaszek, CCS-P, billing manager, credentialing/coding specialist for Northampton Area Pediatrics, LLP, in Northampton, Massachusetts, reminds coders.

However, “in cases when an illness or abnormality is discovered, or a preexisting worsening problem is addressed in conjunction with the physical, if the problem is significant enough to require additional work to perform the key components of a problem-oriented E/M service, an appropriate E/M should be reported with modifier 25 [Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service] in addition to the preventive medicine service code,” Walaszek continues.

Coding caution: “Keep in mind that some payers will not reimburse both a preventive and problem service on the same date of service,” says Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.