MARY Posted Wed 02nd of September, 2015 12:04:12 PM
How can we report an office visit code in addition to the preventive medicine service when extra time is spent counseling and/or coordinating care for obesity? Many payers do not allow diagnosis codes 278.00, 278.01 etc., as primary diagnosis codes when billed with an office visit code (modifier 25) during a preventive service. Can we use time based coding? If so what documentation is required? Is there a different way to get paid for this extra time?
SuperCoder Answered Thu 03rd of September, 2015 02:52:35 AM
Well, you can bill a preventive and E/M service for the same patient on the same DOS. If a problem is encountered or a pre-existing problem is addressed in the process of performing this preventive medicine visit, and the problem is significant enough to require additional workup to perform the key components of a problem-oriented EM service, then the appropriate office/outpatient code 99201–99215 should also be reported. You have to take care of two important things- (1) Is the patient present with acute problem and/or chronic problem required significant additional workup and (2) There should be medical necessity to support an EM service in addition to the preventive visit.
And if the preventive medicine visit is fixed for obesity/morbid obesity, then payer have to consider it as PDX. You also can claim the visit on the basis of time. Hope it helps!