Wiki Help billing multiple CPT's on same date of service

[nca1006]

Hi all! This is my first time posting, so bear with me.

I work in a family practice office with 2 providers. We have had several instances where the patient gets multiple procedures on the same day and I am not positive I am billing it correctly. For example, if a patient comes in for an established visit for f/u of HTN, wellness exam with depression screening, flu shot, and complains of joint pain and gets a 30/40 shot, the following is what I would bill:

OV- 99214-25
Wellness -99397
Depression screening -G0444-59
Injection -96372-59
Meds -J1030
Meds -J1885

My question comes with the use of -25 and -59. Is this correct? I have been taught to put a -25 on the primary procedure for the secondary, and a -59 on each additional procedure. It just doesn't seem right to me, but I can't find any information that applies. Some insurance companies are rejecting these claims and I have looked everywhere online and in all my books for how to bill this type of situation. No other modifiers I can find will work.

Please Help!

Thanks!

 

[mitchellde]

What is the level 4 visit for? You cannot have patient that present symptomatic and also for a wellness. The ICD-10 codes for the Z00 category state general exam WITHOUT complaint, suspected or reported diagnosis.
In addition the excludes 1 exclusion states excludes encounter for signs and symptoms.
If the patient presents complaining of pain then it is a visit for the pain and he wellness should be rescheduled.
If the provider discovers an abnormality then you can use the code for with abnormal finding and you could bill a separate visit level but it would not be a level 4. A visit level with a prevent must be distinctly documented as a separate level 4 without including any components that are already a part of the wellness visit. It is really hard to identify all of these components and have two visit levels identified. Also let’s be real the provider will not ‘discover’ knee pain.
If the provider wishes to treat the pain at the encounter for the wellness then you cannot have a separate visit for this, you can bill the wellness and you can bill the injections. If these injects were for joint pain was it given IM or intra-articular. Also you indicate a flu shot was administered yet you have not coded for it.
So if the drugs were administered IM I would bill
99397- 25
96372
90471 -59 (administration of flu shot)
J1030
J1885
90686 (flu vaccine)
G0444