Wiki Comprehensive wellness visit plus office visit

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rachelb117

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Good morning! I have a question regarding the billing of an Annual wellness visit AND an office visit on the same date of service. Is this usually a common practice? I am starting up for a new company and seem to see this happening a lot and thought that the Annual wellness (9938x - 99397) was comprehensive and any additional work would have to be pretty substantial to qualify for an extra E/M charge. Any advice is welcome and thanks in advance!
 
Some insurances will let you bill for an annual wellness as well as an E&M visit but it's rare and hard to justify. Medicare Advantage plans should but not Medicare as they don't allow for the wellness code. But BC is one that does not allow it either. It was happening a lot in the facility I am at when I first started 6 years ago. I just gathered my information in print to educate the providers and owner(NP) so we could make sure we were billing correctly. As a rule of thumb we simply do not do both.
 
CarlaA said:
Some insurances will let you bill for an annual wellness as well as an E&M visit but it's rare and hard to justify. Medicare Advantage plans should but not Medicare as they don't allow for the wellness code. But BC is one that does not allow it either. It was happening a lot in the facility I am at when I first started 6 years ago. I just gathered my information in print to educate the providers and owner(NP) so we could make sure we were billing correctly. As a rule of thumb we simply do not do both.
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Do you mean "not at all", or do you mean "in conjunction with an E&M visit"?
 
In conjunction with an E& M visit. I apologize for not being more clear with that as I read it again it is indeed misleading
 
rachelb117 said:
Good morning! I have a question regarding the billing of an Annual wellness visit AND an office visit on the same date of service. Is this usually a common practice? I am starting up for a new company and seem to see this happening a lot and thought that the Annual wellness (9938x - 99397) was comprehensive and any additional work would have to be pretty substantial to qualify for an extra E/M charge. Any advice is welcome and thanks in advance!
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I bill for an FQHC and this happens frequently with one of my providers. How insurance pays does depend on the plan. I would recommend putting a modifier 25 on the E/M code and bill it out. In my experience Medicare pays for the preventative visit and we write-off the E/M. Commercial insurance will also pay for the preventative visit and usually processes the E/M depending on the insurance policy (co-pay, coinsurance or deductible).
 
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