Wiki Physicals and Sick Visits

[t_k_hott@yahoo.com]

I have been doing Medical Coding and Billing for 4 years now, and I have never had to do this but I work for an urgent care, and my physician is wanting to know if we can bill Office Visits (99201-99205), and Physical Codes at the same visit. I have read where sometimes the insurances only pay for one code or the other. Or do they pay for one full code and 1/2 of the other allowed amount? Just want to know if someone has billed like this before?

 

[dragonclawz70]

I have been doing Medical Coding and Billing for 4 years now, and I have never had to do this but I work for an urgent care, and my physician is wanting to know if we can bill Office Visits (99201-99205), and Physical Codes at the same visit. I have read where sometimes the insurances only pay for one code or the other. Or do they pay for one full code and 1/2 of the other allowed amount? Just want to know if someone has billed like this before?

Yes, we bill both a physical and if appropriate an office visit at the same visit and they are both covered. Put a 25 modifier on the office visit.

 

[csperoni]

From a coding standpoint, assuming the documentation is all in order, it is certainly possible to perform and code for both.
Despite -25, there will be some payors who simply will not pay for both, or who will reduce the payment. You would have to check the policies of your contracted carriers.
While the article itself is 18 years old, the specific carriers may not be relevant, but addresses this exact issue https://www.aafp.org/pubs/fpm/issues/2006/0400/p58.html
This does also come up on the forum periodically and you may find additional information by searching.

 

[debradwright]

Agree with @csperoni. As long as documentation supports both codes, you can bill them. However there are many payors that will not reimburse for both together.

 

[Cls1530]

I agree with the comments above. I did want to state that we are seeing payers who do not think that the refill of a medication for a chronic condition that is addressed at a preventive visit would support the additional charge. Make sure you providers are providing active treatment to the problem. Not documenting something that could be done via a refill line.

 

[washburncherry@yahoo.com]

In order to bill for a preventive visit and an office visit, a new or existing problem is assessed and managed you can add E/M can be added with modifier -25. Example would be when morbidity/mortality is of concern, when treating an acute problem or exacerbation of, new medications are ordered and diagnostic. The documentation must support the E/M service.