Wiki Please Help!!

[MaribelChavez]

Hi!

I work for a small family practice. We often see patients for annual exams. Our Dr. has been providing other services on the same day as annuals. Anywhere from vaccines to lesion removals. I've billed out for additional services in the past with an E/M visit and modifier 25 attached and have gotten the claims paid. Recently I have been getting denials on the annual code and paid on the additional service. Our manager has spoken to our Dr. about scheduling a separate appointment for procedures but not for vaccines. He likes to save his patients a trip back to our office. The vaccines used are not state supply. Is there any way I can bill out for the admin/vaccines with an annual exam with out getting a denial?

 

[KimKrebs]

You should be able to get reimbursement of vaccines with an E/M. Certain payers require a modifier 25 on the E/M service and others do not. If its an annual exam, the mod would go on the annual. I do not have any trouble with this and I work in a pediatric office where this is a daily occurrence.

If your Dr. is preforming an annual exam+E/M (illness related)+procedure, then I would try to put the modifier on both the E/M (wellness & illness).
However my trouble that I have is getting insurance to pay full plan rates for illness/injury related E/M during an annual exam, even with modifier 25.

Hope that helps!

Kim Krebs
CPEDC

 

[jensanders16@yahoo.com]

Is this new for 2018 charges only? Is it only one carrier? Did you confirm for your area if there have been any changes to the insurance policies for annual visits? It has been a few years since I billed family practice, but for our office for sudden changes in payment, that is always our first stop - the insurance co. website.