Wiki Preventive and sick same day

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stephmescher

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Hello,

Wondering if we could get some guidance on billing Preventive and sick visits same day? CPT states that if an abnormality or a pre-exsisting problem is addressed and the problem is significant enough to require additional work, we are able to bill the E/M with a 25 modifier. If the patient comes in with 3 chronic problems, we know that just refilling prescriptions does not qualify but we were wondering if ordering labs to monitor chronics would? Ex: hyperlipidemia is stable on the medication but ordered a lipid panel for next year.

Thanks
Steph
 
These are 2 different scenarios; sick visit, yes. If you are seeing a patient for their annual physical and they report new acute symptoms that your physician treats, you can bill a low level E/M code with modifier 25. Simply ordering labs or refilling a Rx for a chronic problem is already included in the preventative exam so you can not bill separately for it.

Hope that's helpful.
 
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