July 21, 2016

Fill Two Needs with One Deed? Not Always…

It’s a no-brainer: you’re busy (read: swamped), the schedule is jam-packed,  and patients are not so patient. The most time-saving visit is the “split billing” combo known as a well visit and a sick visit, or so it seems. “The ICD-10 strictly limits the circumstances under which a provider may report a preventative visit and a sick visit for the same patient on the same day”, writes Deborah Mitchell, a compliance consultant and auditor at AAPC. For example, if a patient arrives for a well visit and is symptomatic, per ICD-10 guidelines, the visit no longer constitutes as a preventative visit and must be rescheduled. A sick visit will be billed instead. The split billing, as mentioned above, is rarely appropriate now. “A patient cannot be both well and sick at the same time,” hence the new guidelines.

Nevertheless, there is always an exception to the rule. The CPT guidelines do allow certain exemptions. If an abnormal finding is detected or if a preexisting condition is addressed during the preventative evaluation. If the issue at hand is valid enough to require further work to perform the arduously oriented E/M service and then the office code 99201-99215. Modifier 25 should also be included to signify that a separate, identifiable assessment was provided on the same day as the preventative service. That way, the appropriate and guideline-factored preventative visit is additionally reported.

If you have any questions regarding this restriction or if you need more clarification, please do not hesitate to contact our office. We’d love to hear from you!

About Kate G
Kate is a multi-hyphenated billing and coding fanatic and a highly caffeinated cycle revenue dreamer.