Medical Billing Forum
Billing => Billing => : dmaney August 03, 2012, 05:14:05 PM
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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?
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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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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...
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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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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.