Wiki Preventive Visit with HIV Patients?

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veloso

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Beechhurst, NY
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Hi,
HPI: First visit in our clinic HIV patient came from other state

Can I bill? Initial Preventive Visit (9938x/ Z00.01) with New Sick Visit (9920x/attached modifier 25) for HIV (B20)

Please advise!

Thank you!
 
Yes, the reason for appointment is for HIV Care with General HPI: Patient reported HIV since 2020 adherent with regimen denied any recent illness and here today to connect care for HIV management and for a PCP..... Final Assessment Dx. HIV B20 start Biktravy Meds and Dx. Z00.01 used for labs 8000 categories and the provider billed for both Preventive and Sick Visit E/M
 
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I work for an insurance company in Payment Integrity which conducts audits of claims. From my audit perspective, based on the small amount of information you provided I don't see a preventative visit here. This is based on the fact that you stated the patient came in to establish care as a patient with HIV, what was preventative about the visit? If I was auditing this claim, I would be looking for the separately identifiable services that were preventative in nature and I just don't see it here.

You can absolutely bill both the sick and preventative visit on the same DOS but there needs to be documentation to support both visits and establishing care as a patient with a diagnosed condition doesn't automatically equate to a preventative visit.
 
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