Forum - Questions & Answers

Oct 6th, 2015 - locomah

CPT® question

Can I bill 99396/25 with 99212/25 together.

Oct 6th, 2015 -

re: CPT® question

you only need the modifier on the additional office visit 99212

Oct 6th, 2015 - Odditor 7 

re: CPT® question

Also the problem for the 99212 must be significant. It can be a chronic problem that is worsening or an acute problem that either one need to be acted upon by the provider. The provider needs to at least order meds or tests.

Oct 6th, 2015 - catclayton 6 

re: CPT® question

So to lay it out:

You would bill the 99396/25 and point it to the well visit.

On the second line (same date) you would bill 99212 and point it to the diagnosis that the doctor came across during the well visit, to justify billing an office visit on the same day of a preventative visit.

Does that make sense?

Oct 6th, 2015 - Odditor 7 

re: CPT® question

You would actually bill the 99396 then the 99212-25 and yes you are correct to point the diagnoses. Keep in mind though that to bill each visit you must have enough documentation to meet the criteria of the two separate visits. You cannot count information documented for the wellness visit to the problem visit also. It has to be a significant, separately identifiable problem visit.

Oct 6th, 2015 -

re: CPT® question

no that is incorrect is should be billed like this


99396 DX for well visit

99212/25 - DX for sick visit

always put the modifier on the additional office visit and not the well visit..




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