Medical Billing Coding - Preventative with Problem Visit, cpt, codes
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Thread Topic: Preventative with Problem Visit
Topic Originator: Tara Conte
Post Date May 18, 2012 @ 9:14 AM
Preventative with Problem Visit

Tara Conte
May 18, 2012 @ 9:14 AM Reply  |  Email Friend   |  |Print  |  Top

I have read mixed opinions about coding a preventative exam with a problem exam.  I was under the impression that you could not mix a new patient preventative with an established patient problem on the same date of service.  When I looked this up I was informed that you can't have two (2) new patient visits on the same day because you didn't have to do the "initial" portion of the E/M visit.  Example: New patient 17 years old comes in for annual preventative and presents with strep.
99203 - 25

or should it be:
99213 - 25

I appreciate the help.

Josh CPC
May 20, 2012 @ 8:12 AM Reply  |  Email Friend   |  |Print  |  Top

Try 99383 (59) and 99214 (25)

Tara Conte
May 21, 2012 @ 8:32 AM Reply  |  Email Friend   |  |Print  |  Top

Thank you for the response...question...why use 99383, the patient is 17 wouldn't that be 99384, also from what you are saying I should use an established problem (99214) with MOD 25 with a new preventative (99384) and MOD 59?  So I can't have two new codes for the same patient on the same date of service even if the patient is new and presents with preventative and symptom?  Just a little confused as to why I would place the MOD 59 on the preventative.  Appreciate the help.

May 24, 2012 @ 6:43 AM Reply  |  Email Friend   |  |Print  |  Top

We use 99383 in our practice and we get it paid using modifier 59.  

I assume the strep is not a new condition, hence the 99214.  if it isnt a new condition use 99204 or 99205.  Make sure you use modifier 25.

May 24, 2012 @ 8:53 AM Reply  |  Email Friend   |  |Print  |  Top

Thank you for the response.  We are having a problem with our state (CT) insurance paying a preventative with a problem visit on the same date of service.  I haven't tried the 59 MOD on the preventative yet.  I will and track the reimbursement.  Scenario:  17 year old (established pt) comes in for preventative (yearly) and has had a headache for 3 days.  The coding would be:
I am hopeful this will work.  Appreciate the attention to my question. You have a great day!

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