Re: Separate E/M services question

[Guest guest]

Most insurers will not honor that. Some do. Aetna does. UHC does now, but only pays 50% of their normal miserly rates on the 2nd E & M. Sometimes BCBS/Wellpoint does, but it is inconsistant as heck.

Aetna is probably the best payor we have. They even pay for our mental health screenings (99150). That damn Cigna actually sent something asking us to do the screening but then when we submitted it sent a letter saying we werent' credentialed with their mental health group,. Or was taht GHI?

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]

We always bill it of we do it. But usually we tell patients they must come back unless its really minor. We'll always do it ofr Aetna patietns because we know we'll get paid. We do it some for UHC but we keep it minor since they want to chump us with 50%. HIP of NY pays both--sometimes. I have 2 eobs here now, one they did and one where they didn't.

[Practiceimprovemen t1] 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]

Aetna just started paying the both on the same day in 2006 I believe.

Re: Separate E/M services question

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? SetoSouth Pasadena, CA-- Annie

SkaggsLexington, KY

[Guest guest]

Aetna just started paying the both on the same day in 2006 I believe.

Re: Separate E/M services question

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? SetoSouth Pasadena, CA-- Annie

SkaggsLexington, KY

[Guest guest]

The preventive gets the modifier

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 SafranHurley,,NY

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[Guest guest]

The preventive gets the modifier

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 SafranHurley,,NY

Find phone numbers fast with the New AOL Yellow Pages!

[Guest guest]

UHC pays it here--but cuts the non-preventive code fee in half.

[Practiceimprovemen t1] 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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