Wiki preventive visit and sick visit on same day

[jbhuju]

hello,
i think i did ask the same question in past. can we bill preventive visit and sick visit on same day on same claim with modifier 25 on E & M code. if yes what are requirements? for AWV if provider did review all the chronic condition and its stable do not need to make any changes on medication do we still add seperate E & M code for all the chronic condition that provider did review? please help and thank you .

 

[csperoni]

Yes, if both services were provided and appropriately documented, you may bill both on the same day. You may encounter some carriers having a policy that they will simply not pay for both, regardless of modifier -25.
For the requirements, you need to review the documentation. Cross out everything related to the preventive visit, which will give you the "separately identifiable" portion. Is the leftover amount significant? If yes, level your problem oriented E&M from only the leftover with -25.
The key is that you cannot count any of the same work for both a preventive and a problem oriented visit.

 

[jbhuju]

Yes, if both services were provided and appropriately documented, you may bill both on the same day. You may encounter some carriers having a policy that they will simply not pay for both, regardless of modifier -25.
For the requirements, you need to review the documentation. Cross out everything related to the preventive visit, which will give you the "separately identifiable" portion. Is the leftover amount significant? If yes, level your problem oriented E&M from only the leftover with -25.
The key is that you cannot count any of the same work for both a preventive and a problem oriented visit.

thank you so much. sounds like if provider reviewed all chronic condition and did not make any changes then we cannot bill separate E & M for that correct

 

[csperoni]

thank you so much. sounds like if provider reviewed all chronic condition and did not make any changes then we cannot bill separate E & M for that correct

If the provider is simply listing the problems and/or medications, but not treating the problems nor prescribing medications, it is highly unlikely to meet "separate and significantly identifiable" service to warrant modifier -25. That work is included in the preventive service being provided.