Wiki 2 e&ms?

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pscott

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The Doctor has 2 E&M levels marked, with an "or" pointing to them.
One is 99396, with a wellness DX, and the other is 99215, with dxs of
250.00 and 401.9. He did a urinalysis and a A1C. This is not a Medicare
patient. What is the correct way to code this?
Thanks!
 
It sounds like an annual wellness to me which cannot be coded with a 99215. Just to check a patients chronic conditions does not qualify this to be a 99215. I would code it with a 99396 and if the patient has no benifits for wellness then they will have to pay for the encounter.
 
Can you have 2 E&Ms at the same time? I had a earlier one
where it was a preventative, but the doctor also marked
99212 with a headache DX, I'm new to the E&M stuff,
so I appreciate your help.
Thanks!
 
If the patient has complaint that is faily mild and does not constitute the enitire visit AND you have separate documentation of hx exam and MDM for this complaint the yes you can bill the preventive with the ov using a 25 modifier on the ov. The AMA has stated in this case of a split encounter the ov needs to be of a level 2, that if the patient is so ill that a level 3 or higher is necessary then they are too ill to obtain a wellness visit also.
 
Hi Debra,
Can you tell me where I might find that AMA statement regarding the level should only be a level 2?
Thank you
 
It was on their website several months ago. I was searching there for something else and I found that instead. But when you think about it it does make good sense.
 
prevent with problem visit

I would love to find that on the AMA website..no luck yet. If you have any hints on how I can find it please let me know.

Thanks!

Dena CPC
 
I've been preaching this forever. Please, please tell me where I can find something in black and white to take to our Compliance Officer, as well as the Physicians.
 
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