Wiki Annual wellness visits and sick visit on same dos

[DoRayMi]

Hello Everyone,

According to Medicare, you can code annual wellness along with a sick visit if the sick visit has a 25 modifier on it. Does this apply to commercial insurance as well? I have a new doctor who constantly tries to squeeze in both regardless of age or insurance. Any help provided is most appreciated.

Thank you,

Dolores

 

[Chelle-Lynn]

As always it depends on the carrier, but many carriers follow Medicare guidelines. You just need to ensure that the documentation is clear and meets the stand alone requirements for the sick visit if the claim is audited or needs to be appealed.

 

[JR]

So the modifier is on the E/M visit?. Thanks!

 

[Chelle-Lynn]

Yes, on the E&M.