Wiki 2 e/m

[veloso]

Hi All,
Can I bill '99395 for Well Visit' and add '99213 for Preoperative Exam' / Circumcision Surgery for Balanitis done on same day?

Thank you,
IM

 

[Pathos]

Billing Preventive and Problem Visits by the same provider on the same day is often problematic for most insurance carriers. Correct coding (if documentation and medical necessity support) allows both encounters if you append the correct modifier. However, since both the Preventive and Problem visit have elements that might overlap with each other, a lot of insurance carriers deny as bundled when trying to bill them out. Often they like you to select the encounter you spent the most time on, and then go from there. If medical necessity is there and documentation is strong also, then those claims can be paid through medical review/appeals.

Here is some reading:

AHIMA - article from 2008
AAPC article
MODA Health - Modifier 25

Hope that is helpful!