Wiki OV double billing?

[JLuz]

My family practice provider is billing a lot of new patients with the codes 99386,99204-25. Other members have said that it can be done, but I guess my real question is how often should this be done? She is documenting for it, but I am concerned that she is going to get 'flagged' for an audit by doing so. any thoughts?
She isnt getting paid for both by Medicare because they dont pay 99386, but she is going to try and AWV, 99205-25. That may or may not get paid - any thoughts?

 

[ljmcnamara3]

Hi. Ya know - performing a Preventive Exam and Level 4 New Pt on the same day CAN be done - but really - is there enough documentation to support two separately identifiable E/M services - especially a 99204 where a Comprehensive History, Comprehensive Exam, and Moderate MDM must be performed and documented? That doesn't really leave a lot left over for a Preventive Exam, which is performed when the patient presents with no Chief Complaint. (Note: A Preventive Exam does include the care of a small problem or minor illness in which no additional workup is planned and is transient in nature) I would really make sure you can carve out 2 separate stand alone services. In my opinion, AWV's are a little different but again are best performed when the patient has no problems or illnesses. But it can be done - especially when the provider is using forms for the Wellness Visit and again you can carve out two services. Remember the AWV's require specific documentation and a health risk assessment.....

I hope this was helpful and best of luck!