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Incomplete Physical

Maria Posted Thu 30th of May, 2019 15:56:02 PM
For Commercial Payors how should "incomplete/partial" physicals be billed (provider is only performing G0101 & Q0091 services) ? Preventative CPT code or HCPCS G0101 & Q0091?
SuperCoder Answered Fri 31st of May, 2019 08:46:17 AM

Hi Maria,

 

Thanks for your question.

 

Because your doctor has not completed the physical, you should not code a wellness or preventive exam (99384 series). You should instead bill the encounter based on the time your physician spent counseling the patient.

 

You may code based on the face-to-face counseling minutes with 99401 series.

 

Some insurers, however, don’t cover preventive medicine counseling codes. In this case, you may bill the appropriate-level office visit code e.g., 99211 - 99205.

 

If your provider spends the majority of the encounter on counseling, the visit qualifies for time-based billing.

 

You should link these CPT codes to an appropriate counseling diagnosis. For example, you could assign Z71.9 — Counseling, unspecified, unless the physician’s documentation provides more specificity on the nature of the patient education that he provided.

 

Alternative: You may instead report the preventive medicine service appended with modifier 52 (Reduced services). The modifier indicates that you provided some of the work a well visit involves, but due to certain circumstances, you couldn’t provide the full service. Therefore, you are reporting a reduced charge.

 

Please feel free to write if you have any question.


Thanks

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