Q&A preventative code + E/M w/modifier?

[Amanda]

Pls help me understand how to properly code for a routine well-woman exam (preventative yearly check-up) for an established pt under 39 yrs, AND a separate issue, like depression. (the primary reason for the visit is the preventative care, but during the visit the 2nd reason, depression, is discussed and pt issued rx for meds and/or counseling). Wouldn't it be 99395, 99213-25? I'm SO confused with modifiers.
Thanks for helping.

 

[Lori Woods]

I'm not sure about this but I would have probably used 99395-25. I am curious to know too now what would be correct because I just can't remember where I saw something similar now lol.

 

[Amanda]

I billed it with the -25 on the preventative code, and Insurance denied saying invalid use of modifier. So, I'm left with trying to bill it w/a separate E/M code, but I don't want the code to be denied as inclusive to primary CPT code...UGH - I just really dislike billing things twice!! (better to be right the first time).

 

[Lori Woods]

Yeah i figured that wasn't correct. I am still learning obviously lol. I also would hate denials that is why I am trying to learn all I can & I figure if you don't ask or try you won't learn. Now knowing you were denied for thinking like me I'm glad I said something now I know not to code it that way for future reference. I'm sure one of the coders here can help explain to us the proper way to code this kind of E/M visit. I always seem to think I have read something similar but then can't find it when I need it drives me crazy lol.

 

[Ruth Sheets]

Laureen covered this in the July 2013 Q&A Webinar. You need to have clear documentation of each E/M and it is advisable to have separate chart notes for each. The modifier -25 goes on the 99213 E/M code.

For Laureen's full explanation, you can join the CCO Club and get the transcript and answer sheets.