Wiki Routine physicals/office visits & other services

[Prissyz1]

I need help! I have a family practice provider who sees many patient's for their routine phys. The patient comes in with a huge list of acute illnesses at the same time. Then the patient's need lesion removals etc. I have added modifiers, but most of the insurance companies are not paying for the routine physical. Should I put the modifier -25 on the routine phys in stead of the office visit?

How should I code these?
Example
CPT 99395 dx V70.0
CPT 99213 -25 dx 564.00, 786.50
90658 - v04.81
90471 - v04.81

and

CPT 99397 dx v70.0
CPT 99213 -25 dx 564.00 & 786.50
CPT 17000 -59 dx 702.0
CPT 17003 dx 702.0

Once again Thank You to anyone who can help. I cannot seem to get these insurances to pay for the routine physicals.

 

[tdvrana]

I'd love the answer to that question as well!

I'm sorry I don't have an answer for you, but I do feel your frustration. I have the same problem every time.
I've tried everything in every variation. I find that if I use an E/M with a 25 modifier, the insurance companies (mostly Blue Cross-who incidently are the ones requiring the patient to have these annual exams that they do not end up paying for!) will pay the office visit but not the physical. I go round and round on the phone with them (politely, of course) and some will even tell me what I need to do to get it paid, so I do that and refile it and it still gets denied. Other times, I'm told I was right, they were wrong and they'll "send it up for review" and then I still get denied.
Another big problem is when they do just have a annual exam but also want to get a flu and/or other vaccines. I'll get paid on the vaccines but not the exam! UGH!!!!! I rarely win the battles.
These insurance companies have got to know that these patients come in with everything else under the sun wrong with them or they want skin tags removed or vaccines, so why is it so difficult to get it all paid?????
Does anyone have the answers???

 

[coding4fun]

If you submit the claim as following:

CPT 99397-25 dx v70.0
CPT 17000 -59 dx 702.0
CPT 17003 dx 702.0

Basically the "acute" conditions are considered included within the documentation requirements of the physical. Anthem (BCBC) pays our claims when submitted in this manner. I would much rather leave out the OV then have to battle for that as I know that will not pay when billed on the same DOS as the physical.

Happy Thanksgiving Holiday Everyone!