Annual Wellness Visit

Is it possible to bill and Office Visit for say a cold at the same time as the Annual wellness visit?

For Medicare patients??

Tina

Comments

  • yes. I would recommend using a 25 modifier on both. (yep - I know some folks will disagree - but that is my opinion based on experience).

    Of course, generally, I do NOT recommend the patient see the provider or doctor during an AWV, so this doesn't come up often with most of my clients as the patient is seeing a nurse.

    Don


    Don Self & Associates, Inc

    305 Senter Ave, Whitehouse, TX 75791
    903 871-1172 fax 480-247-5650
    donself@donself.com web: www.donself.com
    free webinars at www.donself.com

    DISCLAIMER: This email has not been scanned for correct spelling, grammar or punctuation. It has been created in the language of Texan and may or may not be understood completely to those north of Kentucky.

  • --001a1141964c0f5296053ec97d9d
    Content-Type: text/plain; charset=UTF-8

    Yes, it is possible and appropriate, just add a modifier -25.

    Now with *Commercial Insurances*, you should check to see how your health
    plans reimburse. Some will not pay for both on the same day, and others
    will reimburse the office visit at 50% of the fee schedule. In addition,
    due to many people having HDHP, the contractual amount usually will hit the
    deductible, and the patient will call your office to complain about having
    an out of pocket expense because their intention was to have their "free"
    physical.

    Our office tries to avoid handling medical issues that require an Office
    Visit on the same day as a Preventive Medicine visit. We do explain the
    reasoning to the patient and, if pressured, we will ask them if they prefer
    to keep the two visits separate or combine them on the same day to save
    them from coming in for two different appointments. We have had patients
    that want to keep them separate, which I will never understand.

    Charlene Endre-Burgett, MS-HCM, CMA (AAMA), CPC, CMCS, CHM, CPOM
    Chief Operating Officer
    North Scottsdale Family Medicine
    LinkedIn: www.linkedin.com/in/charleneburgett



  • Modifier -25 is not added on both- only the E/M code otherwise it may confuse the edits.
    Maxine

    [Description: Description: R:\General\Graphics\ScrogginsGrear\Correct Colors\ScrogginsGrear One Line Signature.png]

    Maxine Lewis, CMM, CPC, CPC-I, CCS-P, CPMA
    Main: 513-771-7070
    Direct: 513-672-4363
    Fax: 513-326-7640
    200 Northland Blvd
    Cincinnati, OH 45246
    mlewis@scrogginsgrear.com
    www.scrogginsgrear.com

  • I would like to ask a question on this subject. I have seen this coming through with a 52 modifier; not only this one but the AWV as well. I was under the impression if it is missing a required element it is not then billable.. yes/no. I just don't it's right to put a 52 on or any other E&M type service.
    Input please!
    Thanks, k

    Karyn Cardenas-Foray, CPC, CPMA ,CHCA, CEMC,CIMC,CSEMC
    AHIMA ICD10 PROFICIENT
    Government Reimbursement Analyst-Sharp Health Care
    PFS-CCD 3rd Floor
    858-499-4382

  • I didn't suggest that the modifier -25 be added to both. I just stated to
    add the -25 modifier and implied to add it to the Office Visit because the
    question was whether it is possible to bill an Office Visit at the same
    time as the Annual Wellness visit. Sorry if there was any confusion.

    Charlene Endre-Burgett, MS-HCM, CMA (AAMA), CPC, CMCS, CHM, CPOM
    Chief Operating Officer
    North Scottsdale Family Medicine
    LinkedIn: www.linkedin.com/in/charleneburgett



  • I did.


    Don


    Don Self & Associates, Inc

    305 Senter Ave, Whitehouse, TX 75791
    903 871-1172 fax 480-247-5650
    donself@donself.com web: www.donself.com
    free webinars at www.donself.com

  • Oh, Maxine responded off of my post, so I was wondering where that came
    from!

    To expand on that. However, there are some plans that may require a
    modifier -25 on both and the biller may have to bypass the edit to have it
    go out that way.

    Charlene Endre-Burgett, MS-HCM, CMA (AAMA), CPC, CMCS, CHM, CPOM
    Chief Operating Officer
    North Scottsdale Family Medicine
    LinkedIn: www.linkedin.com/in/charleneburgett



  • If Flu, 99213 and G0439 done on the same day, would you append mod-25 on both 99213 & G0439 or just the 99213? Thanks, Lily Ybanez


    From: Charlene Burgett
    To: Multiple recipients of list PARTB-L
    Sent: Friday, October 14, 2016 1:43 PM
    Subject: Re: [partb-l] Annual Wellness Visit

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