the OP should be asking this question to the doctor/provider if they don't have access to the patient's medical records.
... the superbill/encounter form is ... not what you use to code or determine where those codes go on the claim form.
But the rest of us out here work in the real world, and need to deal with life as it is lived by these doctors in the real world. And these doctors, whose income is tied directly to their own efforts, are not as enamored of best practices as you and Linda are. When provider behavior in the real world creates questions, real-world answers are sometimes more useful - even though it is also useful to point to best practices afterward.
I am lost in this trail, but from what I have gathered, the patient was probably scheduled for a physical. In the midst of performing the physical, a mass (lump) was discovered upon breast exam. Therefore, I would code the 99396-25, followed by the E/M code. You will be paid 100% of the preventative, and the E/M code will most likely be paid at 25-50%, depending upon the carrier.
It would be great if doctor's were trained, or even knew a tad about coding and the order in which to place codes, but reality says that THEY DO NOT! That is what they have us for; to take their notes, be it via paper or EMR, and put the codes into order for them. With this situation, it really doesn't matter what the patient was scheduled for, but that a physical was performed and a mass in the breast was discovered upon examination. So long as documentation covers both, there should be absolutely no problem.
There's an UNFAIR advantage here since the ORIGINAL post was MODIFIED rather than a new post created to include the information left out (which was significant) of first post.
Let me clarify my question by explaining the reason for the visit: a 40 year old female pt was seen for her annual checkup
We normally get around 10-15 diagnoses codes checked off, 3-5 procedure codes checked off, and around 15 labs checked off - with the odd 3 or 4 immunization codes thrown in from time to time. Only rarely in 17 years have any of these fee slips come to us with the procedure codes listed in the proper order and with the diagnosis codes pointed to the target procedure codes. We get paid for knowing how to do that ourselves.