Author Topic: well visit e/m with sick visit e/m plus mod 25  (Read 1563 times)

dmaney

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well visit e/m with sick visit e/m plus mod 25
« on: August 03, 2012, 02:14:05 PM »
Any advice on billing the following scenarios:
A patient comes in for a well visit and also a sore knee (stated as the reason for visit).  We are getting reimbursed for the well but not the e/m involved in the knee (just an example).  We've been using well e/m plus a sick e/m plus the modifier 25.  No reimbursement for sick e/m.

A patient comes in for a well visit (as stated as the reason for the visit).  During the exam, a suspicious lump is found (now we have a sick visit, right?) Again, we've been using a well e/m plus a sick e/m with modifier 25.  No reimbursement for sick e/m.

Would using modifier 33 for preventative (well) help us to get reimbursed for dr's extra exam and medical decision making?

Michele

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Re: well visit e/m with sick visit e/m plus mod 25
« Reply #1 on: August 05, 2012, 07:19:39 AM »
I don't believe the 33 modifier is going to help.  Without knowing the reason that the e&m wasn't paid it is hard to say.  Have you tried calling the insurance carrier to see why the sick portion was not allowed?  It sounds as if it was coded correctly.
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dmaney

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Re: well visit e/m with sick visit e/m plus mod 25
« Reply #2 on: August 05, 2012, 08:29:35 AM »
Have you been getting paid for sick visits in these circumstances?

Anyone else having this problem?  Or just us?

Will ask person in charge if she has called...

Michele

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Re: well visit e/m with sick visit e/m plus mod 25
« Reply #3 on: August 05, 2012, 02:15:58 PM »
If you bill for a well visit, and an E&M with a medical dx using the 25 modifier, they are usually both allowed.  Occasionally there is a plan that does not allow for both a well visit & E&M for sick visit at same time. 
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deedee

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Re: well visit e/m with sick visit e/m plus mod 25
« Reply #4 on: August 14, 2012, 09:33:49 PM »
it depends on the insurance carrier because as far as I know not all of them allow it. I would check with the insurance carrier.