can I Bill 99215 and 99386 on same date?

re: can I Bill 99215 and 99386 on same date?

CPT® guidelines in the E/M section for Preventive Medicine Services states, "The following codes are used to report the preventive medicine evaluation and management of infants, children, adolescents and adults.

The extent and focus of the services will largely depend on the age of the patient.

If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem or abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate Office/Outpatient code 99201-99215 should also be reported. Modifier 25 should be added to the Office/Outpatient code to indicate that a significant, separately identifiable evaluation and management service was provided on the same day as the preventive medicine service. The appropriate preventive medicine service is additionally reported.

An insignificant or trivial problem/abnormality that is encountered in the process of performing the preventive medicine evaluation and management service and which does not require additional work and the performance of the key components of a problem-oriented E/M service should not be reported."

Hope this helps

re: can I Bill 99215 and 99386 on same date?

Code 99215 requires a comprehensive H&P --The preventive codes require a comprehensive evaluation based on age. It is difficult to imagine both being performed. Probably best to bring back for preventive physical. IMO.

re: can I Bill 99215 and 99386 on same date?

No, don't do it.

Too much overlap. I think the payer will ask for the record and the record won't support both.

re: can I Bill 99215 and 99386 on same date?

agreed - there's no way there can be enough documentation to cover the requirements for both evaluations, and the 99215 has (nearly!) a TON of criteria to cover to bill that time/complexity. You'll have to choose which better describes your contact, and/or reschedule the wellness check for another appt.

re: can I Bill 99215 and 99386 on same date?

Agree that it is highly unlikely both can truly be met. Also, some payers have policies about preventive medicine and problem visits at same encounter. I have worked with one payer that would allow payment for no higher than level 2 problem visit to be paid with preventive medicine at same time.

re: can I Bill 99215 and 99386 on same date?

I have to agree with the others that the documentation would most likely not support both charges. Is the 99215, truly meeting the level of documentation needed for that high an E/M charge? While insurance companies will most likely request documentation, I would do an audit on the records and check for the true documentation level for both before billing. Also, my experience in the past is that while insurance companies may give you a hard time with paying both, if supported both can be reimbursed and there needs to be clear, differentiating documentation for both services. Mostly likely one will be paid at a reduced rate.

re: can I Bill 99215 and 99386 on same date?

Also, isn't 99386 for a NEW patient and 99215 for an ESTABLISHED patient? Would you have meant 99205 to bill along with the Preventive exam? In that case, most coders would agree that it is not accepted practice to code a problem-oriented E/M with the Preventive exam on NEW patients regardless of payer because the history and exam components overlap and documentation can only be counted one time. Referenced from AAPC "Coding Edge" April 2011