I have 2 dates of service where the provider is trying to bill for both a well visit and a sick visit. I say there is not enough medical necessity to bill for the sick visit with the well visit even with a -25 modifier.
First is well visit for 15 month old. Reason for appointment is well check. History of Present Illness is Acute: 2 day history of sudden onset of scant amount of clear runny nose, not treated and without additional symptoms. There was no fever and the treatment was humidify room and bulb suction as needed, no change in diet or activity indicated and rtc for worsening new or persistent symptoms. The immunizations were given.
Second is well visit for 18 month old. Reason for appointment 1. 18 month well check 2. Chapped cheeks. History of Present Illness is Extended: seen 9 days earlier for viral illness, all sx resolved and longstanding redness of cheeks in response to many different foods and activities, treated with OTC moisturizer with some improvement. No fever Treatment: 1. Unspecified viral infection, in conditions classified elsewhere and of unspecified site Notes: resolved....normal activity 2. Rash and other nonspecific skin eruption Notes: try calendula ointment bid rtc if persists. Immunization given.
Please help me show the provider these did not justify the 99213 even if he did a review of systems and history. The patient's mom is very upset that she has to pay for the 99239 and 99213.
First is well visit for 15 month old. Reason for appointment is well check. History of Present Illness is Acute: 2 day history of sudden onset of scant amount of clear runny nose, not treated and without additional symptoms. There was no fever and the treatment was humidify room and bulb suction as needed, no change in diet or activity indicated and rtc for worsening new or persistent symptoms. The immunizations were given.
Second is well visit for 18 month old. Reason for appointment 1. 18 month well check 2. Chapped cheeks. History of Present Illness is Extended: seen 9 days earlier for viral illness, all sx resolved and longstanding redness of cheeks in response to many different foods and activities, treated with OTC moisturizer with some improvement. No fever Treatment: 1. Unspecified viral infection, in conditions classified elsewhere and of unspecified site Notes: resolved....normal activity 2. Rash and other nonspecific skin eruption Notes: try calendula ointment bid rtc if persists. Immunization given.
Please help me show the provider these did not justify the 99213 even if he did a review of systems and history. The patient's mom is very upset that she has to pay for the 99239 and 99213.