Preventative cpt 99391

[Kinlaw30]

Hi,

Hope someone could answer this question for me. I want to know if MD see patient for preventative cpt 99391 and patient also come in and have complaints about cough and sore throat should complaint of sore throat and cough be billed separately from preventative?

Thanks in advance.

[Michele]

Yes a separate E&M can be billed but the provider must document each service separately in the patient's chart, and the amount of time spent on only the cough & sore throat would be considered in the E&M code, not the entire time of the visit. 

[Kinlaw30]

Provider also wanted to know since she seen patient for physical exam and symptoms of a cough, sore throat could she bill the patient ? I submitted for all services on same claim and insurance said it went towards patient deductible. I told her I wasn’t for sure if she could bill the patient since it was not billed out separately from physical exam. Would the provider also need to have something in writing for patients to sign stating that anything they discuss outside their physical exam or well check will be billed separately to insurance?  Could she code the seperate complaint or symptoms as a 99213 regular OV?

[PMRNC]

If you already billed it you need to file corrected claim. if it's a non granddfathered ERISA plan to which you are trying to get reimbursement for the physical without cost sharing you might want to get the plan's SPD as they may be grandfathered and the visit would also be re-processed all going to deductible.

[Kinlaw30]

Thank you