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Well care and sick visit coding

Sandra Posted Thu 02nd of August, 2012 20:46:03 PM

I want to make sure there have not been any changes. But can a pediatric physician code a visit both for well and sick. We have a lot of patients that come in for a well care visit and we end up see them or finding issues that would suggest a sick visit also. We perform the well care as long as the patient is fever free, but there are other things that may be found that would suggest that we could use both a well care CPT with V20.xx and a sick visit CPT with corresponding sick diagnosis with 25 modifier.

SuperCoder Answered Mon 06th of August, 2012 13:42:04 PM

It's best to refer back to the CPT under preventive medicine services. It states that if the additional work done to address a problem is significant enough, you can bill for an additional office visit using modifier 25. It also states that if the problem is trivial, it should be included in the well visit. It's best to have separate documentation supporting the extra work in the patient's chart. Also, if you are contracted with the insurance, you'll need to see if they have a policy on paying for 2 E&M codes on the same day.

SuperCoder Answered Mon 06th of August, 2012 13:47:46 PM

Yes, you can bill both well care and sick visit together, with modifier 25 appended with the sick E/M code.

Remember: You need to look at the amount of documentation. You cannot use documentationused in well child code again for E/M code for sick visit. So, no double dipping. Also, if the problem found during well child is minor and does not warrant much additional documentation, then you should not bill E/M separately. If the sick visit reason is significant enough forcing the physician to document separately for that condition, then you can bill the separate E/M code with modifier 25.

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