Wiki Need help with Modifiers and Billing!

[brachi91@gmail.com]

We have a patient who came for a well visit, received a flu shot, and ended up with a UTI, so the visit was also a sick visit. A urinalysis was done, a pap smear, and the patient was counseled about stopping to smoke.

How would we code/bill this visit to get everything/maximum payment for this claim? The doctor feels that it should be a well and a sick visit, as she spent enough time with this patient for both. There are dx's to support all the procedures...

99396, 99213, 90656, 90471, Q0091, 81003, 99000, 99406. Where would modifiers go in order for this to get maximum payment, and which modifiers would be appropriate?

Thanks!

 

[OCD_coder]

The Preventative Service guidelines in the CPT manual do allow for a separate E&M in certain circumstances and it goes so far as to tell you exactly what modifier is need and which E&M code to apply it to.

In order to support both services, as an auditor, I would be looking for literally separate documentation for both services. Separate reports are best so that the same exam and history is not combined to use for both E&M codes. I would also be looking for documentation of the providers clinical course from the Chief Complaint, HPI, exam and the assessment and plan to support the E&M for the UTI found with the UA - all separate from the preventative service performed at the same visit.