Billing for a Preventative Visit and Sick Visit at the Same Time

Is the patient obligated to pay for what the insurance does not cover?

Does it not seem like double billing when a Wellness Visit is billed for $248 and then a Sick Visit for $143? Total for 1 PCP visit - $391.

re: Billing for a Preventative Visit and Sick Visit at the Same Time

it is not the same service... if you think about it the patient comes in for a physical --that's one service. Then for convenience they are seen for other medical diagnosis which require a much different process than a wellness exam.

I bill the physical with the V dx code (age dependent)
then bill the office visit 992xx -25 with 25 mod separately with the sick dx codes.

Back in the day doctors would have a patient come in for a physical and if the patient were ill then they simply performed the office visit and sometimes just reschedule the physical for another day . They never got paid for both.

I attended a seminar in 2007 which confirmed this process of sending two different claims linking to the appropriate modifiers is good.


Side note: patient's tend to call and say I was there for a physical and the office visit was subject to a co payment. I simply explain KINDLY well think about it like this... If you take your car for an oil change and tune up does that mean if the mechanic fixes anything else on the same visit that it should be included??? ABSOLUTELY NOT. Their expertise to address the other issues are separate. =) This explanation always helps them understand.

re: Billing for a Preventative Visit and Sick Visit at the Same Time

You can always tell the patient that an Office visit for the problem cannot be done on the same day as the Preventive Visit. However, if you look in CPT® under the Preventive Medicine section, you will find the answer to your question in the narrative portion before the actual listing of the codes 99381-99397.

Charlene Endre-Burgett, MS, CMA (AAMA), CPC, CMCS, CHM, CPOM
Administrator, North Scottsdale Family Medicine
Blog: www.charleneburgett.wordpress.com
LinkedIn: www.linkedin.com/in/charleneburgett