Re: Separate E/M services question

[Guest guest]

I think you have indeed been very lucky as my experience is most

don’t pay for both and if they do, the discount the E & M

significantly and I usually have to send in a copy of the progress note to

justify it.

I almost never bill both unless it is a significantly different

problem, like dizziness or a shoulder injury, causing one to do more of a

history and physical details that would otherwise not be done in a routine

preventative health exam.

Right now I am even fighting Aetna on my E & M code for a

Mallet finger and application of a static splint. They allowed the splint

fee ($45) and disallowed the E & M code as included. I haven’t

figure out how I was supposed to know she needed the splint without evaluating

the injury first this is how it goes in NJ.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Seto

Sent: Wednesday, October 01, 2008 6:28 PM

To:

Subject: Separate E/M services question

To the group,

My biller opined today that she feels that we have been very lucky to

be getting paid for both a preventive health visit and a problem-

oriented E/M service, such as when a patient comes in for a physical

and also complains of a significant problem, such as dizziness or

joint pain or abdominal pain, etc. I was under the impression that

most insurers honor the modifier -25 code and will pay for both E/M

services but she thinks that most physicians will not bother

submitting the dual codes and when they do, only one of them gets

paid. So my two questions to the group are:

1. How often do you submit a claim that has both a preventive health

visit PLUS a problem-oriented E/M visit?

2. How often to you get paid for both E/M charges?

Seto

South Pasadena, CA

[Guest guest]

We have billed this way a total of 4

times. We’ve only been paid for it once. Steve will either

tell the patient that they need to come back the next day (this only happens if

the patient takes an extraordinary amount of time anyways) or, more typically, we

just suck up the loss and bill the preventive exam. The time to fight the

denial isn’t worth it.

Pratt

Office Manager

Oak Tree Internal Medicine P.C.

From: [mailto: ] On Behalf Of Seto

Sent: Wednesday, October 01, 2008

3:28 PM

To:

Subject:

Separate E/M services question

To the

group,

My biller opined today that she feels that we have been very lucky to

be getting paid for both a preventive health visit and a problem-

oriented E/M service, such as when a patient comes in for a physical

and also complains of a significant problem, such as dizziness or

joint pain or abdominal pain, etc. I was under the impression that

most insurers honor the modifier -25 code and will pay for both E/M

services but she thinks that most physicians will not bother

submitting the dual codes and when they do, only one of them gets

paid. So my two questions to the group are:

1. How often do you submit a claim that has both a preventive health

visit PLUS a problem-oriented E/M visit?

2. How often to you get paid for both E/M charges?

Seto

South Pasadena, CA

[Guest guest]

We have billed this way a total of 4

times. We’ve only been paid for it once. Steve will either

tell the patient that they need to come back the next day (this only happens if

the patient takes an extraordinary amount of time anyways) or, more typically, we

just suck up the loss and bill the preventive exam. The time to fight the

denial isn’t worth it.

Pratt

Office Manager

Oak Tree Internal Medicine P.C.

From: [mailto: ] On Behalf Of Seto

Sent: Wednesday, October 01, 2008

3:28 PM

To:

Subject:

Separate E/M services question

To the

group,

My biller opined today that she feels that we have been very lucky to

be getting paid for both a preventive health visit and a problem-

oriented E/M service, such as when a patient comes in for a physical

and also complains of a significant problem, such as dizziness or

joint pain or abdominal pain, etc. I was under the impression that

most insurers honor the modifier -25 code and will pay for both E/M

services but she thinks that most physicians will not bother

submitting the dual codes and when they do, only one of them gets

paid. So my two questions to the group are:

1. How often do you submit a claim that has both a preventive health

visit PLUS a problem-oriented E/M visit?

2. How often to you get paid for both E/M charges?

Seto

South Pasadena, CA

[Guest guest]

Plus, usually the patient is supposed to pay 2 copays -- one for the preventive E/M and one for the regular E/M.

Many patients balk at that.

Locke, MD

From: [mailto: ] On Behalf Of Kathy SaradarianSent: Wednesday, October 01, 2008 4:42 PMTo: Subject: RE: Separate E/M services question

I think you have indeed been very lucky as my experience is most don’t pay for both and if they do, the discount the E & M significantly and I usually have to send in a copy of the progress note to justify it.

I almost never bill both unless it is a significantly different problem, like dizziness or a shoulder injury, causing one to do more of a history and physical details that would otherwise not be done in a routine preventative health exam.

Right now I am even fighting Aetna on my E & M code for a Mallet finger and application of a static splint. They allowed the splint fee ($45) and disallowed the E & M code as included. I haven’t figure out how I was supposed to know she needed the splint without evaluating the injury first this is how it goes in NJ.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From: [mailto: ] On Behalf Of SetoSent: Wednesday, October 01, 2008 6:28 PMTo: Subject: Separate E/M services question

To the group,My biller opined today that she feels that we have been very lucky to be getting paid for both a preventive health visit and a problem- oriented E/M service, such as when a patient comes in for a physical and also complains of a significant problem, such as dizziness or joint pain or abdominal pain, etc. I was under the impression that most insurers honor the modifier -25 code and will pay for both E/M services but she thinks that most physicians will not bother submitting the dual codes and when they do, only one of them gets paid. So my two questions to the group are:1. How often do you submit a claim that has both a preventive health visit PLUS a problem-oriented E/M visit?2. How often to you get paid for both E/M charges? SetoSouth Pasadena, CA

[Guest guest]

Plus, usually the patient is supposed to pay 2 copays -- one for the preventive E/M and one for the regular E/M.

Many patients balk at that.

Locke, MD

From: [mailto: ] On Behalf Of Kathy SaradarianSent: Wednesday, October 01, 2008 4:42 PMTo: Subject: RE: Separate E/M services question

I think you have indeed been very lucky as my experience is most don’t pay for both and if they do, the discount the E & M significantly and I usually have to send in a copy of the progress note to justify it.

I almost never bill both unless it is a significantly different problem, like dizziness or a shoulder injury, causing one to do more of a history and physical details that would otherwise not be done in a routine preventative health exam.

Right now I am even fighting Aetna on my E & M code for a Mallet finger and application of a static splint. They allowed the splint fee ($45) and disallowed the E & M code as included. I haven’t figure out how I was supposed to know she needed the splint without evaluating the injury first this is how it goes in NJ.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From: [mailto: ] On Behalf Of SetoSent: Wednesday, October 01, 2008 6:28 PMTo: Subject: Separate E/M services question

To the group,My biller opined today that she feels that we have been very lucky to be getting paid for both a preventive health visit and a problem- oriented E/M service, such as when a patient comes in for a physical and also complains of a significant problem, such as dizziness or joint pain or abdominal pain, etc. I was under the impression that most insurers honor the modifier -25 code and will pay for both E/M services but she thinks that most physicians will not bother submitting the dual codes and when they do, only one of them gets paid. So my two questions to the group are:1. How often do you submit a claim that has both a preventive health visit PLUS a problem-oriented E/M visit?2. How often to you get paid for both E/M charges? SetoSouth Pasadena, CA

[Guest guest]

treat the acute problem and have pt come back for rtn visit for Preventive health

To the group,My biller opined today that she feels that we have been very lucky to be getting paid for both a preventive health visit and a problem- oriented E/M service, such as when a patient comes in for a physical

and also complains of a significant problem, such as dizziness or joint pain or abdominal pain, etc. I was under the impression that most insurers honor the modifier -25 code and will pay for both E/M services but she thinks that most physicians will not bother

submitting the dual codes and when they do, only one of them gets paid. So my two questions to the group are:1. How often do you submit a claim that has both a preventive health visit PLUS a problem-oriented E/M visit?

2. How often to you get paid for both E/M charges? SetoSouth Pasadena, CA -- M.D.www.elainemd.com

You only go through this life but once. Go in the directions of your dreams and live the life you've imagined.

[Guest guest]

Hi ,In 2005, when I first learned about modifier 25, I had to pitch a fit to get my billers to try billing an E & M code along with a preventive code on the same DOS, but when they did try it, amazingly, we were paid for both.

Pumped by the success, I continued to bill both for any situation where the person needed prescriptions other than birth control, and except for Aetna, all insurers paid for both. Even Medicare will pay for the Welcome to Medicare physical on the same day as a 99214 for management of DM, HTN, osteoporosis, etc.. I have always done two completely separate notes for these situations, and occasionally had to submit the notes to get paid, but get paid I did....Until this year. As of Jan 08 my two biggest private payers, Humana and Anthem, started bundling ...so I make patients schedule two visits and make sure I tell them why.

Annie

To the group,

My biller opined today that she feels that we have been very lucky to

be getting paid for both a preventive health visit and a problem-

oriented E/M service, such as when a patient comes in for a physical

and also complains of a significant problem, such as dizziness or

joint pain or abdominal pain, etc. I was under the impression that

most insurers honor the modifier -25 code and will pay for both E/M

services but she thinks that most physicians will not bother

submitting the dual codes and when they do, only one of them gets

paid. So my two questions to the group are:

1. How often do you submit a claim that has both a preventive health

visit PLUS a problem-oriented E/M visit?

2. How often to you get paid for both E/M charges?

Seto

South Pasadena, CA

-- Annie SkaggsLexington, KY

[Guest guest]

I don't bill both often, but my main payer (BCBS) always pays both

fully with only 1 co-pay. It's been too tough to get other payers to

pay for it, so I don't really bill them that way.

Haresch

>

> To the group,

> My biller opined today that she feels that we have been very lucky to

> be getting paid for both a preventive health visit and a problem-

> oriented E/M service, such as when a patient comes in for a physical

> and also complains of a significant problem, such as dizziness or

> joint pain or abdominal pain, etc. I was under the impression that

> most insurers honor the modifier -25 code and will pay for both E/M

> services but she thinks that most physicians will not bother

> submitting the dual codes and when they do, only one of them gets

> paid. So my two questions to the group are:

>

> 1. How often do you submit a claim that has both a preventive health

> visit PLUS a problem-oriented E/M visit?

> 2. How often to you get paid for both E/M charges?

>

> Seto

> South Pasadena, CA

>

[Guest guest]

This seems to be a regional issue -Most insurers in New Mexico do pay on a 25 modifier, including some of those that reject the same claims in other states.Also, in this state, where over 50% on the insurers are local, the culture of reimbursement is also.I don't bill both often, but my main payer (BCBS) always pays bothfully with only 1 co-pay. It's been too tough to get other payers topay for it, so I don't really bill them that way. Haresch>> To the group,> My biller opined today that she feels that we have been very lucky to > be getting paid for both a preventive health visit and a problem- > oriented E/M service, such as when a patient comes in for a physical > and also complains of a significant problem, such as dizziness or > joint pain or abdominal pain, etc. I was under the impression that > most insurers honor the modifier -25 code and will pay for both E/M > services but she thinks that most physicians will not bother > submitting the dual codes and when they do, only one of them gets > paid. So my two questions to the group are:> > 1. How often do you submit a claim that has both a preventive health > visit PLUS a problem-oriented E/M visit?> 2. How often to you get paid for both E/M charges?> > Seto> South Pasadena, CA>

[Guest guest]

This seems to be a regional issue -Most insurers in New Mexico do pay on a 25 modifier, including some of those that reject the same claims in other states.Also, in this state, where over 50% on the insurers are local, the culture of reimbursement is also.I don't bill both often, but my main payer (BCBS) always pays bothfully with only 1 co-pay. It's been too tough to get other payers topay for it, so I don't really bill them that way. Haresch>> To the group,> My biller opined today that she feels that we have been very lucky to > be getting paid for both a preventive health visit and a problem- > oriented E/M service, such as when a patient comes in for a physical > and also complains of a significant problem, such as dizziness or > joint pain or abdominal pain, etc. I was under the impression that > most insurers honor the modifier -25 code and will pay for both E/M > services but she thinks that most physicians will not bother > submitting the dual codes and when they do, only one of them gets > paid. So my two questions to the group are:> > 1. How often do you submit a claim that has both a preventive health > visit PLUS a problem-oriented E/M visit?> 2. How often to you get paid for both E/M charges?> > Seto> South Pasadena, CA>

[Guest guest]

A silly question to those who have successfully billed acute visit code along with a prevention visit. Which code gets the -25 modifier?

The 99213 or 214 or the prevention visit code?

Mike Safran

Hurley,,NY

Find phone numbers fast with the New AOL Yellow Pages!

[Guest guest]

When it has worked for me the 25 goes on the preventive code, or if you are doing a surgical procedure with 99213/4, the 25 goes on the 99213/4 code.I have one patient with PA BCBS and they will pay bothRI insurers usually either kick out the claim completely or will just pay the lower of the two codes and deny the other. Lynn To: From: Mike113593@...Date: Thu, 2 Oct 2008 08:03:20 -0400Subject: Re: Separate E/M services question

A silly question to those who have successfully billed acute visit code along with a prevention visit. Which code gets the -25 modifier?

The 99213 or 214 or the prevention visit code?

Mike Safran

Hurley,,NY

Find phone numbers fast with the New AOL Yellow Pages!

Get more out of the Web. Learn 10 hidden secrets of Windows Live. Learn Now

[Guest guest]

When it has worked for me the 25 goes on the preventive code, or if you are doing a surgical procedure with 99213/4, the 25 goes on the 99213/4 code.I have one patient with PA BCBS and they will pay bothRI insurers usually either kick out the claim completely or will just pay the lower of the two codes and deny the other. Lynn To: From: Mike113593@...Date: Thu, 2 Oct 2008 08:03:20 -0400Subject: Re: Separate E/M services question

A silly question to those who have successfully billed acute visit code along with a prevention visit. Which code gets the -25 modifier?

The 99213 or 214 or the prevention visit code?

Mike Safran

Hurley,,NY

Find phone numbers fast with the New AOL Yellow Pages!

See how Windows connects the people, information, and fun that are part of your life. See Now

[Guest guest]

I thought the -25 always went on the E & M code. If I

do a procedure, I will sometimes put that modifier (I believe -52 or something

like that) on the procedure. Sometimes I do both.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Lynn Ho

Sent: Thursday, October 02, 2008 8:08 AM

To: practiceimprovement1

Subject: RE: Re: Separate E/M services question

When it has worked for me the 25 goes on the

preventive code,

or if you are doing a surgical procedure with 99213/4, the 25 goes on the

99213/4 code.

I have one patient with PA BCBS and they will pay both

RI insurers usually either kick out the claim completely or will just pay the

lower of the two codes and deny the other.

Lynn

To:

From: Mike113593@...

Date: Thu, 2 Oct 2008 08:03:20 -0400

Subject: Re: Separate E/M services question

A

silly question to those

who have successfully billed acute visit code along with a prevention visit.

Which code gets the -25 modifier?

The 99213 or 214 or

the prevention visit code?

Mike Safran

Hurley,,NY

Find phone numbers fast with the New AOL Yellow

Pages!

See how Windows connects the people, information, and fun

that are part of your life. See Now

[Guest guest]

For my experience:

1 – have done it maybe 10 times, and

got partially reimbursed maybe 4 times, denied the rest.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From: [mailto: ] On Behalf Of Seto

Sent: Wednesday, October 01, 2008

4:28 PM

To:

Subject:

Separate E/M services question

To the

group,

My biller opined today that she feels that we have been very lucky to

be getting paid for both a preventive health visit and a problem-

oriented E/M service, such as when a patient comes in for a physical

and also complains of a significant problem, such as dizziness or

joint pain or abdominal pain, etc. I was under the impression that

most insurers honor the modifier -25 code and will pay for both E/M

services but she thinks that most physicians will not bother

submitting the dual codes and when they do, only one of them gets

paid. So my two questions to the group are:

1. How often do you submit a claim that has both a preventive health

visit PLUS a problem-oriented E/M visit?

2. How often to you get paid for both E/M charges?

Seto

South Pasadena, CA

[Guest guest]

The more common time I use the -25 modifier is for a follow up (perhaps HTN or DM)

and the person has a wart for freezing, or ear wax impaction for flushing. The

modifier goes on the 99213/99214 and I list that first. Then I list the procedure

code.On the claim, be sure to link the right diagnosis with the E & M /

procedure. So, if " viral wart " is diagnosis #4 (after say DM, HTN,

Chol), then the procedure gets a " 4 " in box 24E (diagnosis pointer) on the

CMS1500 form. If I don't do the diagnosis pointer correctly, it'll

likely get denied. If I do, there's a much better chance it gets paid (but not

always for certain).TimOn

Thu, October 2, 2008 8:16 am EDT, Kathy Saradarian wrote:

I thought the -25 always went on the E

& M code. If Ido a procedure, I will sometimes put that modifier (I

believe -52 or somethinglike that) on the procedure. Sometimes I do

both.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From: [mailto: ] On Behalf Of Lynn

HoSent: Thursday, October 02, 2008 8:08 AMTo: practiceimprovement1 Subject: RE: Re: Separate E/M services

question

When it has worked for me the 25 goes on thepreventive code, or if you are doing a surgical procedure with 99213/4, the

25 goes on the99213/4 code.I have one patient with PA BCBS and they will

pay bothRI insurers usually either kick out the claim completely or will just

pay thelower of the two codes and deny the other. Lynn

To:

From: Mike113593@...Date: Thu, 2

Oct 2008 08:03:20 -0400Subject: Re: Separate E/M

services question

Asilly question to thosewho

have successfully billed acute visit code along with a prevention visit. Which code gets the -25 modifier?The 99213 or 214 orthe prevention

visit code?Mike SafranHurley,,NY

Find phone numbers fast with the New AOL YellowPages!

See how Windows connects the people, information, and funthat are part of your life. See Now

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.----------------------------------------

[Guest guest]

This type of inconvenient, incoherent nonsense with regards to

billing and insurance, is the best reason in my mind to get rid of

insurance altogether.

>

> For my experience:

>

>

>

> 1 - have done it maybe 10 times, and got partially reimbursed

maybe 4 times,

> denied the rest.

>

>

>

> A. Eads, M.D.

>

> Pinnacle Family Medicine, PLLC

>

> phone fax

>

> P.O. Box 7275

>

> Woodland Park, CO 80863

>

> www.PinnacleFamilyMedicine.com

>

> _____

>

> From:

> [mailto: ] On Behalf Of

Seto

> Sent: Wednesday, October 01, 2008 4:28 PM

> To:

> Subject: Separate E/M services question

>

>

>

> To the group,

> My biller opined today that she feels that we have been very lucky

to

> be getting paid for both a preventive health visit and a problem-

> oriented E/M service, such as when a patient comes in for a

physical

> and also complains of a significant problem, such as dizziness or

> joint pain or abdominal pain, etc. I was under the impression that

> most insurers honor the modifier -25 code and will pay for both

E/M

> services but she thinks that most physicians will not bother

> submitting the dual codes and when they do, only one of them gets

> paid. So my two questions to the group are:

>

> 1. How often do you submit a claim that has both a preventive

health

> visit PLUS a problem-oriented E/M visit?

> 2. How often to you get paid for both E/M charges?

>

> Seto

> South Pasadena, CA

>

[Guest guest]

So, I walk into the supermarket to buy bread, eggs and milk.... total is exactly $10

and, conveniently, I have a single $10 bill in my pocket.While walking to the

check out, I notice that the pasta is on sale, so I pick up 3 boxes for $0.99

each.At the register, the check out person says the bill is $12.97.I

hand her the $10 bill and say, " Well, I came here to get only $10 worth of

bread, eggs and milk. Therefore, this pasta is bundled with the other items and I'm

NOT paying for it. Just because I'm picking it up at the same time is

irrelevant. " What would happen next?... how is medical care

different from everything else in our economy?!And, how can we address

this?TimOn Thu,

October 2, 2008 9:12 am EDT, wrote:

NO KIDDING! look at all the emails about t his! BOX this. point

this. check this . what drivel.To earn a living. -

write up another piece, so I can send it to my legislators again. I sent the last

one.

This type of inconvenient, incoherent nonsense with regards to billing and

insurance, is the best reason in my mind to get rid of insurance

altogether.>> For my experience:> > > > 1 - have done it maybe 10 times, and got

partially reimbursed maybe 4 times,> denied the rest.> > > > A. Eads, M.D.> > Pinnacle

Family Medicine, PLLC> > phone

fax> > P.O. Box 7275> > Woodland Park, CO

80863> > www.PinnacleFamilyMedicine.com> > _____ > >From: > [mailto: ]

On Behalf Of Seto> Sent: Wednesday, October 01, 2008 4:28 PM> To: > Subject: Separate E/M services question> > > > To the group,> My biller opined today that

she feels that we have been very lucky to > be getting paid for both

a preventive health visit and a problem- > oriented E/M service, such as

when a patient comes in for a physical > and also complains of a

significant problem, such as dizziness or > joint pain or abdominal pain,

etc. I was under the impression that > most insurers honor the modifier -25

code and will pay for both E/M > services but she thinks that most

physicians will not bother > submitting the dual codes and when they do,

only one of them gets > paid. So my two questions to the group are:> > 1. How often do you submit a claim that has both a preventive health > visit PLUS a problem-oriented E/M visit?> 2. How often

to you get paid for both E/M charges?> > Seto> South

Pasadena, CA>

-- If you are a patient please allow up to 12

hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD 115 Mt

Blue Circle ph fax 207 778

3544

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.----------------------------------------

[Guest guest]

On the 99213 or 214 if you're pairing it with a preventive code, also. The more common time I use the -25 modifier is for a follow up (perhaps HTN or DM) and the person has a wart for freezing, or ear wax impaction for flushing.  The modifier goes on the 99213/99214 and I list that first. Then I list the procedure code.On the claim, be sure to link the right diagnosis with the E & M / procedure.  So, if "viral wart" is diagnosis #4 (after say DM, HTN, Chol), then the procedure gets a "4" in box 24E (diagnosis pointer) on the CMS1500 form.  If I don't do the diagnosis pointer correctly, it'll likely get denied. If I do, there's a much better chance it gets paid (but not always for certain).TimI thought the -25 always went on the E & M code. If Ido a procedure, I will sometimes put that modifier (I believe -52 or somethinglike that) on the procedure. Sometimes I do both.Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffingFrom: [mailto: ] On Behalf Of Lynn HoSent: Thursday, October 02, 2008 8:08 AMTo: practiceimprovement1 Subject: RE: Re: Separate E/M services questionWhen it has worked for me the 25 goes on thepreventive code, or if you are doing a surgical procedure with 99213/4, the 25 goes on the99213/4 code.I have one patient with PA BCBS and they will pay bothRI insurers usually either kick out the claim completely or will just pay thelower of the two codes and deny the other. LynnTo: From: Mike113593aolDate: Thu, 2 Oct 2008 08:03:20 -0400Subject: Re: Separate E/M services questionAsilly question to thosewho have successfully billed acute visit code along with a prevention visit. Which code gets the -25 modifier?The 99213 or 214 orthe prevention visit code?Mike SafranHurley,,NYFind phone numbers fast with the New AOL YellowPages!See how Windows connects the people, information, and funthat are part of your life. See Now---------------------------------------- Malia, MDMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments.----------------------------------------

[Guest guest]

Tim , forget the pasta. buy wine. go home and drink it .nothing will change but you won't mind as much.

So, I walk into the supermarket to buy bread, eggs and milk.... total is exactly $10

and, conveniently, I have a single $10 bill in my pocket.While walking to the

check out, I notice that the pasta is on sale, so I pick up 3 boxes for $0.99

each.At the register, the check out person says the bill is $12.97.I

hand her the $10 bill and say, " Well, I came here to get only $10 worth of

bread, eggs and milk. Therefore, this pasta is bundled with the other items and I'm

NOT paying for it. Just because I'm picking it up at the same time is

irrelevant. " What would happen next?... how is medical care

different from everything else in our economy?!And, how can we address

this?TimOn Thu,

October 2, 2008 9:12 am EDT, wrote:

NO KIDDING! look at all the emails about t his! BOX this. point

this. check this . what drivel.To earn a living. -

write up another piece, so I can send it to my legislators again. I sent the last

one.

This type of inconvenient, incoherent nonsense with regards to billing and

insurance, is the best reason in my mind to get rid of insurance

altogether.>> For my experience:> > > > 1 - have done it maybe 10 times, and got

partially reimbursed maybe 4 times,> denied the rest.> > > > A. Eads, M.D.> > Pinnacle

Family Medicine, PLLC> > phone

fax> > P.O. Box 7275> > Woodland Park, CO

80863> > www.PinnacleFamilyMedicine.com> > _____ > >

From: > [mailto: ]

On Behalf Of Seto> Sent: Wednesday, October 01, 2008 4:28 PM> To:

> Subject: Separate E/M services question> > > > To the group,> My biller opined today that

she feels that we have been very lucky to > be getting paid for both

a preventive health visit and a problem- > oriented E/M service, such as

when a patient comes in for a physical > and also complains of a

significant problem, such as dizziness or > joint pain or abdominal pain,

etc. I was under the impression that > most insurers honor the modifier -25

code and will pay for both E/M > services but she thinks that most

physicians will not bother > submitting the dual codes and when they do,

only one of them gets > paid. So my two questions to the group are:> > 1. How often do you submit a claim that has both a preventive health > visit PLUS a problem-oriented E/M visit?> 2. How often

to you get paid for both E/M charges?> > Seto> South

Pasadena, CA>

-- If you are a patient please allow up to 12

hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD 115 Mt

Blue Circle ph fax 207 778

3544

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com

--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.------------------------------------------ If you are a patient please allow up to 12 hours for a reply by email/

please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

Tim, LOL. You made my morning J

Pratt

Office Manager

Oak Tree Internal Medicine P.C.

From: [mailto: ] On Behalf Of Malia, MD

Sent: Thursday, October 02, 2008

6:45 AM

To: jnantonucci@...;

practiceimprovement1

Subject: Re:

Re: Separate E/M services question

So, I walk into the supermarket to buy bread, eggs and

milk.... total is exactly $10 and, conveniently, I have a single $10 bill in my

pocket.

While walking to the check out, I notice that the pasta is on sale, so I pick

up 3 boxes for $0.99 each.

At the register, the check out person says the bill is $12.97.

I hand her the $10 bill and say, " Well, I came here to get only $10 worth

of bread, eggs and milk. Therefore, this pasta is bundled with the other items

and I'm NOT paying for it. Just because I'm picking it up at the same

time is irrelevant. "

What would happen next?

.... how is medical care different from everything else in our economy?!

And, how can we address this?

Tim

On Thu, October 2, 2008 9:12 am EDT,

wrote:

NO KIDDING! look at all

the emails about t his! BOX this. point this. check this . what drivel.

To earn a living.

- write up another piece, so I can send it to my legislators again. I

sent the last one.

On Thu, Oct 2, 2008 at 9:06 AM, l_spikol lspikolptd (DOT) net>

wrote:

This type of

inconvenient, incoherent nonsense with regards to

billing and insurance, is the best reason in my mind to get rid of

insurance altogether.

>

> For my experience:

>

>

>

> 1 - have done it maybe 10 times, and got partially reimbursed

maybe 4 times,

> denied the rest.

>

>

>

> A. Eads, M.D.

>

> Pinnacle Family Medicine, PLLC

>

> phone fax

>

> P.O. Box 7275

>

> Woodland Park, CO 80863

>

> www.PinnacleFamilyMedicine.com

>

> _____

>

>

From:

> [mailto: ]

On Behalf Of

Seto

> Sent: Wednesday, October 01, 2008 4:28 PM

> To:

> Subject: Separate E/M services question

>

>

>

> To the group,

> My biller opined today that she feels that we have been very lucky

to

> be getting paid for both a preventive health visit and a problem-

> oriented E/M service, such as when a patient comes in for a

physical

> and also complains of a significant problem, such as dizziness or

> joint pain or abdominal pain, etc. I was under the impression that

> most insurers honor the modifier -25 code and will pay for both

E/M

> services but she thinks that most physicians will not bother

> submitting the dual codes and when they do, only one of them gets

> paid. So my two questions to the group are:

>

> 1. How often do you submit a claim that has both a preventive

health

> visit PLUS a problem-oriented E/M visit?

> 2. How often to you get paid for both E/M charges?

>

> Seto

> South Pasadena, CA

>

--

If you are a patient please allow up to 12 hours for a reply by email/

please note the new email address.

Remember that e-mail may not be entirely secure/

MD

ph fax

----------------------------------------

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY

14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

-- Confidentiality Notice --

This email message, including all the attachments, is for the sole use of the

intended recipient(s) and contains confidential information. Unauthorized use

or disclosure is prohibited. If you are not the intended recipient, you may not

use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and

destroy all copies of the original message, including attachments.

----------------------------------------

[Guest guest]

Not paying for pasta eh...The police will pick you up and put you in

the part of town with poor Italians-The Spaghetto.

> >

> > For my experience:

> >

> >

> >

> > 1 - have done it maybe 10 times, and got

> partially reimbursed

> maybe 4 times,

> > denied the rest.

> >

> >

> >

> > A. Eads, M.D.

> >

> > Pinnacle

> Family Medicine, PLLC

> >

> > phone

> fax

> >

> > P.O. Box 7275

> >

> > Woodland Park, CO

> 80863

> >

> > www.PinnacleFamilyMedicine.com

> >

> > _____

> >

> >

> From:

> > [mailto: ]

> On Behalf Of

> Seto

> > Sent: Wednesday, October 01, 2008 4:28 PM

> > To:

> > Subject: Separate E/M services question

> >

> >

> >

> > To the group,

> > My biller opined today that

> she feels that we have been very lucky

> to

> > be getting paid for both

> a preventive health visit and a problem-

> > oriented E/M service, such as

> when a patient comes in for a

> physical

> > and also complains of a

> significant problem, such as dizziness or

> > joint pain or abdominal pain,

> etc. I was under the impression that

> > most insurers honor the modifier -25

> code and will pay for both

> E/M

> > services but she thinks that most

> physicians will not bother

> > submitting the dual codes and when they do,

> only one of them gets

> > paid. So my two questions to the group are:

> >

> > 1. How often do you submit a claim that has both a preventive

> health

> > visit PLUS a problem-oriented E/M visit?

> > 2. How often

> to you get paid for both E/M charges?

> >

> > Seto

> > South

> Pasadena, CA

> >

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

> --

> If you are a patient please allow up to 12

> hours for a reply by email/

> please note the new email address.

> Remember

> that e-mail may not be entirely secure/

> MD

> 115 Mt

> Blue Circle

>

> ph fax 207 778

> 3544

>

>

>

>

>

>

>

>

>

>

>

> ----------------------------------------

> Malia, MD

>

> Malia

> Family Medicine & Skin Sense Laser

> 6720 Pittsford-Palmyra Rd.

> Perinton

> Square Mall

> Fairport, NY 14450

>

> (phone / fax)

> www.relayhealth.com/doc/DrMalia

> www.SkinSenseLaser.com

>

> --

> Confidentiality Notice --

> This email message, including all the attachments, is

> for the sole use of the intended recipient(s) and contains

confidential information.

> Unauthorized use or disclosure is prohibited. If you are not the

intended recipient,

> you may not use, disclose, copy or disseminate this information.

If you are not the

> intended recipient, please contact the sender immediately by reply

email and destroy

> all copies of the original message, including attachments.

> ----------------------------------------

>

[Guest guest]

The 25 goes on the 213 or 4. Most will cut the payment for that one in half. You

can also have patients return for a counseling visit for things you have found.

These can be billed by time and pay well.

________________________________

From: on behalf of Mike113593@...

Sent: Thu 10/2/2008 6:03 AM

To:

Subject: Re: Separate E/M services question

A silly question to those who have successfully billed acute visit code along

with a prevention visit. Which code gets the -25 modifier?

The 99213 or 214 or the prevention visit code?

Mike Safran

Hurley,,NY

________________________________

Find phone numbers fast with the New AOL Yellow Pages

<http://yellowpages.aol.com/?NCID=emlweusyelp00000001> !

[Guest guest]

UHC is suppose to be doing nation wide. Great West does not, most others do,

including medicare. It is not based on time, you need to bill based on time for

that and document it as such.

It is usually for a patient who comes in for a phyical and you discover a

significant problem that needs to be addressed fully. I get paid for this all

the time, but you need to key the codes to the correct diagnosis.

________________________________

From: on behalf of Pratt

Sent: Wed 10/1/2008 4:51 PM

To:

Subject: RE: Separate E/M services question

We have billed this way a total of 4 times. We've only been paid for it once.

Steve will either tell the patient that they need to come back the next day

(this only happens if the patient takes an extraordinary amount of time anyways)

or, more typically, we just suck up the loss and bill the preventive exam. The

time to fight the denial isn't worth it.

Pratt

Office Manager

Oak Tree Internal Medicine P.C.

________________________________

From:

[mailto: ] On Behalf Of Seto

Sent: Wednesday, October 01, 2008 3:28 PM

To:

Subject: Separate E/M services question

To the group,

My biller opined today that she feels that we have been very lucky to

be getting paid for both a preventive health visit and a problem-

oriented E/M service, such as when a patient comes in for a physical

and also complains of a significant problem, such as dizziness or

joint pain or abdominal pain, etc. I was under the impression that

most insurers honor the modifier -25 code and will pay for both E/M

services but she thinks that most physicians will not bother

submitting the dual codes and when they do, only one of them gets

paid. So my two questions to the group are:

1. How often do you submit a claim that has both a preventive health

visit PLUS a problem-oriented E/M visit?

2. How often to you get paid for both E/M charges?

Seto

South Pasadena, CA

[Guest guest]

UHC does not do this nationwide. They were supposed to start last year but claimed technical difficulties.Those claims do not get paid.They pay the lesser of the two CPTS.As said, this is completely regional.To: From: Jim.Kennedy@...Date: Thu, 2 Oct 2008 12:24:39 -0600Subject: RE: Separate E/M services question

UHC is suppose to be doing nation wide. Great West does not, most others do, including medicare. It is not based on time, you need to bill based on time for that and document it as such.

It is usually for a patient who comes in for a phyical and you discover a significant problem that needs to be addressed fully. I get paid for this all the time, but you need to key the codes to the correct diagnosis.

From: on behalf of PrattSent: Wed 10/1/2008 4:51 PMTo: Subject: RE: Separate E/M services question

We have billed this way a total of 4 times. We’ve only been paid for it once. Steve will either tell the patient that they need to come back the next day (this only happens if the patient takes an extraordinary amount of time anyways) or, more typically, we just suck up the loss and bill the preventive exam. The time to fight the denial isn’t worth it.

Pratt

Office Manager

Oak Tree Internal Medicine P.C.

From: [mailto: ] On Behalf Of SetoSent: Wednesday, October 01, 2008 3:28 PMTo: Subject: Separate E/M services question

To the group,My biller opined today that she feels that we have been very lucky to be getting paid for both a preventive health visit and a problem- oriented E/M service, such as when a patient comes in for a physical and also complains of a significant problem, such as dizziness or joint pain or abdominal pain, etc. I was under the impression that most insurers honor the modifier -25 code and will pay for both E/M services but she thinks that most physicians will not bother submitting the dual codes and when they do, only one of them gets paid. So my two questions to the group are:1. How often do you submit a claim that has both a preventive health visit PLUS a problem-oriented E/M visit?2. How often to you get paid for both E/M charges? SetoSouth Pasadena, CA

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