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Well visits with a sick component

Patti Posted Sat 01st of December, 2012 00:59:05 AM

Could you give us some advice on handling co-pays on the well visits when there is a sick component or abnormality found on the visit?
Otitus, sinusitis or bronchospasm
Scoliosis
New diagnosis of allergic rhinitis
New acne with Rx given
How can we let parents know that these things are not part of the well physical and are required documentation on the HICFA when we bill?

Their insurance requires that they pay a co-pay or the insurance places the sick com-ponent to their deductible. We bill the abnormal findings with a -25 modifier on the well visit.

SuperCoder Answered Mon 03rd of December, 2012 17:42:15 PM

Hi,

We will get back on this soon. We are working on it.

Thanks

SuperCoder Answered Wed 12th of December, 2012 18:50:31 PM

Hi there! I would put this information in your financial policy, which all patients sign when they join your practice. Let them know that if a problem is found during the course of a well child exam and the insurer requires copays on sick visits, then a copay may be required for such visits.

Sincerely,

Torrey Kim, CPC
Editor, Pediatric Coding Alert

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