Wiki Bundling Codes

[jouanlychen]

Hi,

My doctor is an Internal Medicine physician, she constantly patient for well women exam, however, when the patient comes in that often states that she has other issues, ex. a cold, various infection and etc. What is a appropriate code to bill, since Medicare does not paid a preventative and a office visit on the same day?

 

[Pam Warren]

Well, you're partly right. Medicare won't pay the preventive visit (unless it's an IPPE or AWV), but they will pay the office visit. Bill 99212-99215 with a -25 modifier. In New England, we are required to reduce the amount of the preventive visit by the amount of the sick visit, so that the patient has less responsibility for the encounter. In fact, our contractor, NHIC encourages this for the benefit of the patient. I am not sure what your contractor allows, but it is appropriate to bill both, as long as your office visit is clearly separate, clearly documented, and when appending the -25, meets "significant" and separately identifiable from the preventive care.You may also separately bill the pap, Q0091 and breast/pelvic, G0101, for reimbursement, if the coverage criteria is met.