Wiki Well Visit and Sick Visit Billed On The Same Day

[jpulli03]

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.

 

[tstickel]

In reading your post, I would bill the Well Child visits with 99392, and the sick visit with 99212-25. The second one, I would also bill the immunization.

 

[meenda]

I agree with the 99392 & 99212-25 and immunizations. Based on Documentation, I often bill 99392 with 99213 if it's warranted. Moms are not happy with the new way health care works.....they don't like that they have to pay higher deductibles, and less is covered. But its the way it is.

 

[KERRIEA]

We would not bill a separate e/m for either of these visits. CPT states that if an abnormality is encountered or a preexisting problem is addressed and is significant enough to require additional work.. then you can bill an additional e/m. These problems seem very minor and self resolving and not significant enough (in my opinion) to bill an additional e/m.

 

[meenda]

I use 99392-25 and either 99212-25 or 99213-25 depending on the documentation, but my physician documents them each separately (we are still paper, and she does 2 notes) If a treatment plan is built, then it would be a level 3. I use 25 modifier on each, especially if there is an immunization or they bundle the 99392 with the injection code (69460 is what we use for most) I have the issue of parents complaining about the bills also, but I explain that it is a standard billing practice, and that if there was a medical issue addressed, we have the right to bill for it. They are slowly learning......its a SLOW process!!