Forum - Questions & Answers

Jun 27th, 2011 - Shannan 28 

dx codes for annual wellness

Are we just supposed to use the v70 series of dx codes for these visits? Or just the other issues that are dealt with at these visits?

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Jun 27th, 2011 -

re: dx codes for annual wellness

use the V70.0 code for the CPT® that pertains to the wellness, and if you are also addressing problems, link those codes to the 9921x-25.

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Jun 27th, 2011 - Shannan 28 

re: dx codes for annual wellness

So for the annual wellness G0438 I use the V70.0, but I am still attaching an E&M code to that as well???? Isnt the G0438 all inclusive

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Jun 28th, 2011 -

re: dx codes for annual wellness

If the patient was scheduled for a preventative exam, but wound up having complaints that are addressed or an abnormal discovery was found during the exam, you would code those under your sick visit E/M code 992xx with mod 25. The preventative exam only gets the V70.0. This is call a split bill-you split out the sick visit from the well visit. Per CMS rules the total amount of E/M charges for this visit cannot exceed the cost of the preventative code charge. What you have to do is leave the price of the sick E/M code at full price and adjust the price of the preventative code. Ex:99397=$350 and 99213 mod 25=$80. You would bill 99213 $80 and 99397 $270 for the total charges of E/M on this dos as the total price does not exceed $350. You only need to pull out the pertinent elements to support the sick part of the visit to decide what level your code will support. The rest of the head to toe exam falls under the preventative part of the visit. If the patient has chronic illnesses and is on medication you can list these separately under the sick visit as long as the doc is addressing them today. A medication refill counts as the sick visit as well.

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Jun 28th, 2011 - Shannan 28 

re: dx codes for annual wellness

Thank You so much for your help

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