Wiki New Patient Preventive w/Problem based E&M question

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Coding Preventative with E/M

Yes you can bill for both with a 25 modifier on the office visit. Even the insurance companies are sending out notices to patients & physicians offices. This letter is letting patients know that they may receive a bill for their copayment. Insurances will pay and some will try to deny however, I always tight and haven't lost yet. The CPT book even states they can be billed together under the chapter heading with modifier 25. I offered to mail a copy of it to patients that have "Oh by the ways" during the visit. This is when they stated that we were committing insurance fraud and that's when I offered to send it to them as this was always their way of getting out of paying their copay that was not collected at the time of the visit, since it was scheduled for a physicals.
 
Just an FYI - ICD-10 CM codes for preventive, Category Z00.0-, and Z01.4- have exclude 1 notes that state they exclude encounter for signs and symptoms. An exclude 1 means it is a pure exclusion and cannot be coded together. Therefore if a patient presents for a preventive but has symptomatic complaints, you cannot bill both, you can have an office encounter for the symptoms and reschedule the preventive. I bring it up so that offices can begin to plan for this
 
mitchellde said:
Just an FYI - ICD-10 CM codes for preventive, Category Z00.0-, and Z01.4- have exclude 1 notes that state they exclude encounter for signs and symptoms. An exclude 1 means it is a pure exclusion and cannot be coded together. Therefore if a patient presents for a preventive but has symptomatic complaints, you cannot bill both, you can have an office encounter for the symptoms and reschedule the preventive. I bring it up so that offices can begin to plan for this
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So you're saying when ICD 10 hits, separate office visits e/m codes will be non-billable with annual physical codes?
 
Then the visit documentation would not meet the criteria of a preventive encounter. The ICD-10 CM book states under the excludes 1 note to code to the signs and symptoms only. I think you need to discuss this with the physician. Most physicians I have talked yo are not comfortable documenting acute symptoms and treatment that cannot be coded. They would rather have it explained to the patient that if they which to have symptomatic issues discussed and or treated, the preventive will need yo be rescheduled. You should examine your ICD-10 CM book, if you do not have one it is a great idea to obtain one to learn all of these complexities.
 
mitchellde said:
Then the visit documentation would not meet the criteria of a preventive encounter. The ICD-10 CM book states under the excludes 1 note to code to the signs and symptoms only. I think you need to discuss this with the physician. Most physicians I have talked yo are not comfortable documenting acute symptoms and treatment that cannot be coded. They would rather have it explained to the patient that if they which to have symptomatic issues discussed and or treated, the preventive will need yo be rescheduled. You should examine your ICD-10 CM book, if you do not have one it is a great idea to obtain one to learn all of these complexities.
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I was under the impression that if the patient came in requesting annual physical, and addressed that they have other issues they want the doctor to evaluate then the annual physical would be billable along with a separate office visit for the separate problem.

Or are you saying if during the annual physical the doctor finds something else wrong, then we cant bill a separate e/m, that would be included with the annual physcial?
 
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For ICD-10 CM there will be no way to bill using a Z00.0- code with codes for other diagnosis. If you select the codes that states with abnormal findings then you can add the codes for the abnormal findings and bill a high level visit with a 33 modifier instead of a preventive. The affordable care act states that if the reason for the encounter is preventive then there cannot be a separately reportable encounter, this was the reason for the 33 modifier. However for ICD-9 if the patients presents with issues and also wants a preventive then the argument is the reason for the encounter was not primarily preventive and you are allowed to bill both and the patient owes a co pay for the visit. However with ICD-10 CM you cannot code presenting issues with the preventive Z00.0- codes, you can only report abnormal findings, but then the primary reason for the visit is preventive so you can still not report a separately payable visit, but you can report a visit level that is met by the entire document and append the 33 modifier to allow the patient to not owe the copay.
 
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