Wiki Preventive and EM coding

[jimifetil]

Good day

Can anyone help me how to properly code a preventive (99385 etc) and a EM (99214,99202 etc) if the patient:

a. comes in for annual PE without other conditions

b. comes in for annual PE with chronic conditions but no treatment only refills

c. come in for annual PE with other condition

thank you

 

[mitchellde]

A. = preventive only
B. = preventive only
C. = preventive + ov with 25 modifier if it is a patient complaint ( this will change with ICD -10 CM) OR if it an abnormal finding during the well visit then OV+ 33 modifier.
With ICD-10 CM you will not be able to bill a preventive with a symptom, you will code the symptom with an OV and defer the preventive to another day.
If it is an abnormal finding with ICD-10 CM you will chose the well dx code with abnormal finding and bill the E&M with the 33 modifier.

 

[clopez]

Hello,

I've come across this scenario where it's an incidental finding for example on exam of cardiovascular system a systolic click was heard the MD ordered and Echo with findings of Mitral regurgitation.

No HPI elements
Problem focused exam: crediting only the Cardiovascular
Moderate MDM based on new prob with work-up, ordered the echo, with risk of undiagnosed new problem

based on this the documentation supports a 99212 What do you think Debra?

 

[mitchellde]

the affordable care act says you cannot charge a separately payable office visit when the primary reason for the visit is preventive. when the patient presents for a scheduled annual with no current symptoms and the provider discovers an abnormality then this is still primarily prevent which eliminates the possibility of a separate office encounter, which is why the 33 modifier was created. you bill a high level office visit that is met by the documentation ( I have corrected the earlier post, sorry for the confusion) and append a 33 modifier. This is supported by the December 2010 CPT assistant. You may need to appeal to get this to pay as many providers are unsure of the 33 modifier.
therefore for this scenario I would bill the level of service met by the entire documentation and append the 33, use the V70 dx code followed by the abnormality

 

[jimifetil]

Thank you very much for the responce this will help me to properly code our patients