Wiki Preventive Visit/ E/M visit

[lindafay1123]

I am following up on a claim the follow cpt codes where billed 99395, Q0091, 99212, 81025, and 81002 the labs got paid. Also the Q0091 got paid the two E.M code got denied at inclusive and can not be billed on the same dos. I understand that the 99212 needs a modifier 25 the dx code that was used on all where V70.0 the insurance is united healthcare.

I believe that the 99212 needs the 25 and the Q0091 was to be included in the 99395 but since its been paid is there anything I can do not with it.

 

[mitchellde]

If the only reason the patient came to the office was for a preventive encounter then that is all you can bill you cannot add the 99212. Even if there is discussion of pre-exisiting conditions and going over labs. That is the point of the yearly preventive. In order to bill both a preventive and the office visit the patient must initiate both, the patient must state they are there for the preventive and state that they have an active symptom. so by pointing the V70.0 code to the 99212, tells me there was no symptomatic reason for the office visit and it cannot be billed.
The Q0091 is inclusive and should not be billed with the preventive so you sholud have billed only the preventive E&M with the labs.

 

[lindafay1123]

I understand that the Q code should not of been billed. I am just starting this job and am following up on old claims that someone else has done. now that the
Q code has already been paid what are my options with the Preventive visit code, does it have to be wrote off.

 

[mitchellde]

If the reason for the visit was preventive then you need to submit a corrected claim with only the preventive 99395. plust the labs if they were performed in house, if they were not performed inhouse then they should not have been billed either. If the payer agress with the corrected claim they will pay you the difference that is owed if any or they will request a refund for the balance if any.