Shade Posted Thu 02nd of October, 2014 09:10:22 AM
IF A PT. WAS SEEN FOR A WELLNESS VISIT AND PRESCRIPTION WAS GIVEN WITH A DX. OF HYPERCHOLESTEROLEMIA, CAN THAT VISIT BE BILLED AS 99381 WITH O/V CODE TOGETHER. I KNOW THAT O/V CODE CAN BE BILLED WITH -25 BUT THIS VISIT DX. IS A CHRONIC DISEASE THAT PT HAS AND A RX WAS GIVEN AT THE WELLNESS VISIT. PLEASE HELP.
SuperCoder Answered Fri 03rd of October, 2014 08:25:57 AM
Thanks for your question. 99381; Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year). This code is specific for an infant. Was your provider treating an infant?
If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem or abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate Office/Outpatient code 99201-99215 should also be reported. Modifier 25 should be added to the Office/Outpatient code to indicate that a significant, separately identifiable evaluation and management service was provided on the same day as the preventive medicine service. The appropriate preventive medicine service is additionally reported.
An insignificant or trivial problem/abnormality that is encountered in the process of performing the preventive medicine evaluation and management service and which does not require additional work and the performance of the key components of a problem-oriented E/M service should not be reported.
The "comprehensive" nature of the Preventive Medicine Services codes 99381-99397 reflects an age and gender appropriate history/exam and is not synonymous with the "comprehensive" examination required in Evaluation and Management codes 99201-99350.