RE: BILLING - SURG PROCEDURE and MED OFFICE VISIT SAME DAY??

[Guest guest]

I have never seen any insurance that pays both a preventive visit & a

problem-focused E/M in the same visit. That is one of those things that

coding gurus like to talk about but I've never had both covered together

(even using the -25 modifier, etc). Otherwise, yes definitely code the E/M

+ cholesterol discussion + cyst excision together (w/ -25) & they should be

paid.

BILLING - SURG PROCEDURE and MED OFFICE

VISIT SAME DAY??

I have often billed for both in the same day but unsure if they were both

being paid at my

prior clinic as I had no way to track those numbers, just kept running from

patient to

patient without much understanding of the business side. Now I am

interested.

Examples:

1) Removing a sebaceous cyst and also counseling on cholesterol (gee, gotta

talk about

something besides the weather and may as well bill for it if you do) so...

11401 - link to sebaceous cyst

99213 - link to 272.0 high chol

2) During a physical you see a very suspicious mole so you biopsy it

99385 - link to V72.31

99212 - link to nevus, uncertain nature 238.2

11100 - (biopsy) link to 238.2

(I am often confused on physicals about whether to link to anything other

than V70, or

V72.31 because then you have to put another E/M code which inflates the

patient's

bill beyond the physical exam, but I do feel like a biopsy should be

charged if done, BUT

then don't ya have to indicate the suspicios mole under a 99212ish code so

it all fits

together nicely in package???)

HELP!!!???

Thanks!

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

[Guest guest]

: and I routinely bill preventive and E/M codes for multiple PPO's and Medicare and rarely are denied. We bill electronically through Thin clearinghouse and ensure the additional coding for the E/M is appropriate. Preventive visits do not cover evaluation and management. You must decrease the preventive charge for your code for medicare patients by the amount of the E/M service, but insurance companies should pay these. I would appeal each if you are denied or just have them come back in a month for the E/M services. P.S. only Cigna and Unitedhealthcare routinely deny claims. Brock DO wrote: I have never seen any insurance that pays both a preventive visit & aproblem-focused E/M in

the same visit. That is one of those things thatcoding gurus like to talk about but I've never had both covered together(even using the -25 modifier, etc). Otherwise, yes definitely code the E/M+ cholesterol discussion + cyst excision together (w/ -25) & they should bepaid.-----Original Message-----From: [mailto: ] On Behalf Of roxywibleSent: Wednesday, January 11, 2006 1:28 PMTo: Subject: BILLING - SURG PROCEDURE and MED OFFICEVISIT SAME DAY??I have often billed for both in the same day but unsure if they were bothbeing paid at my prior clinic as I had no way to track those numbers, just kept running frompatient to patient without much understanding of the business side. Now I aminterested.Examples: 1) Removing a sebaceous

cyst and also counseling on cholesterol (gee, gottatalk about something besides the weather and may as well bill for it if you do) so... 11401 - link to sebaceous cyst 99213 - link to 272.0 high chol2) During a physical you see a very suspicious mole so you biopsy it 99385 - link to V72.31 99212 - link to nevus, uncertain nature 238.2 11100 - (biopsy) link to 238.2 (I am often confused on physicals about whether to link to anything otherthan V70, or V72.31 because then you have to put another E/M code which inflates thepatient's bill beyond the physical exam, but I do feel like a biopsy should becharged if done, BUT then don't ya have to indicate the suspicios mole under a 99212ish code soit all fits together nicely in

package???)HELP!!!???Thanks!PamelaPamela Wible, MDFamily & Community Medicine, LLC3575 st. #220 Eugene, OR 97405roxywible@...

[Guest guest]

My billing service said the same thing,

but I pitched a fit to try it and so far all but Anthem are paying the

preventive code plus the 99213 or 4-25.

Annie

BILLING - SURG

PROCEDURE and MED OFFICE

VISIT SAME DAY??

I have often billed for both in the same day but

unsure if they were both

being paid at my

prior clinic as I had no way to track those

numbers, just kept running from

patient to

patient without much understanding of the business

side. Now I am

interested.

Examples:

1) Removing a sebaceous cyst and also counseling

on cholesterol (gee, gotta

talk about

something besides the weather and may as well bill

for it if you do) so...

11401 - link to sebaceous

cyst

99213 - link to 272.0

high chol

2) During a physical you see a very suspicious

mole so you biopsy it

99385 - link to V72.31

99212 - link to nevus,

uncertain nature 238.2

11100 - (biopsy) link to

238.2

(I am often confused on physicals

about whether to link to anything other

than V70, or

V72.31 because then you have to

put another E/M code which inflates the

patient's

bill beyond the physical exam, but I

do feel like a biopsy should be

charged if done, BUT

then don't ya have to indicate the

suspicios mole under a 99212ish code so

it all fits

together nicely in package???)

HELP!!!???

Thanks!

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

[Guest guest]

You must have better companies

there. I tried that several times & it was never paid. I’m

starting to think I need to pick a better state than Ohio, based on others

practice stories here.

BILLING - SURG

PROCEDURE and MED OFFICE

VISIT SAME DAY??

I have often billed for both in the same day but

unsure if they were both

being paid at my

prior clinic as I had no way to track those

numbers, just kept running from

patient to

patient without much understanding of the business

side. Now I am

interested.

Examples:

1) Removing a sebaceous cyst and also counseling

on cholesterol (gee, gotta

talk about

something besides the weather and may as well bill

for it if you do) so...

11401 - link to sebaceous

cyst

99213 - link to 272.0

high chol

2) During a physical you see a very suspicious

mole so you biopsy it

99385 - link to V72.31

99212 - link to nevus,

uncertain nature 238.2

11100 - (biopsy) link to

238.2

(I am often confused on physicals

about whether to link to anything other

than V70, or

V72.31 because then you have to

put another E/M code which inflates the

patient's

bill beyond the physical exam, but I

do feel like a biopsy should be

charged if done, BUT

then don't ya have to indicate the

suspicios mole under a 99212ish code so

it all fits

together nicely in package???)

HELP!!!???

Thanks!

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

[Guest guest]

Well, unfortunately UHC is our biggest payor

here so maybe that has a lot to do with it. Do you ever have pt’s

complain about the large $$$ that you billed their insurance? People here seem

to still think that an “office call” (whatever than means) is a set

fee of ~ $45 for everything.

BILLING - SURG

PROCEDURE and MED OFFICE

VISIT SAME DAY??

I have often billed for both in the same day but

unsure if they were both

being paid at my

prior clinic as I had no way to track those

numbers, just kept running from

patient to

patient without much understanding of the business

side. Now I am

interested.

Examples:

1) Removing a s! ebaceous cyst and also counseling

on cholesterol (gee, gotta

talk about

something besides the weather and may as well bill

for it if you do) so...

11401 - link to sebaceous

cyst

99213 - link to 272.0

high chol

2) During a physical you see a very suspicious

mole so you biopsy it

99385 - link to V72.31

99212 - link to nevus,

uncertain nature 238.2

11100 - (biopsy) link to

238.2

(I am often confused on physicals

about whether to link to anything other

than V70, or

V72.31 because then you have to

put another E/M code which inflates the

patient's

bill beyond the physical exam, but I

do feel like a biopsy should be

charged if done, BUT

then don't ya have to indicate the

suspicios mole under a 99212ish code so

it all fits

together nicely in package???)

HELP!!!???

Thanks!

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

[Guest guest]

That brings another question to mind for

me. Do most of you do a lot of preventive visits/physicals? For

some reason, my pt’s rarely come in & say “I need an annual

physical.” Do you prompt the visit or do the pt’s? I

usually end up doing all of the preventive items piece meal as I go along (ie,

lets make sure you’ve had your colonoscopy, PSA, etc, ). Maybe I

need to push pt’s more towards an annual preventive visit.

BILLING - SURG

PROCEDURE and MED OFFICE

VISIT SAME DAY??

I have often billed for both in the same day but

unsure if they were both

being paid at my

prior clinic as I had no way to track those

numbers, just kept running from

patient to

patient without much understanding of the business

side. Now I am

interested.

Examples:

1) Removing a sebaceous cyst and also counseling

on cholesterol (gee, gotta

talk about

something besides the weather and may as well bill

for it if you do) so...

11401 - link to sebaceous

cyst

99213 - link to 272.0

high chol

2) During a physical you see a very suspicious

mole so you biopsy it

99385 - link to V72.31

99212 - link to nevus,

uncertain nature 238.2

11100 - (biopsy) link to

238.2

(I am often confused on physicals

about whether to link to anything other

than V70, or

V72.31 because then you have to

put another E/M code which inflates the

patient's

bill beyond the physical exam, but I

do feel like a biopsy should be

charged if done, BUT

then don't ya have to indicate the

suspicios mole under a 99212ish code so

it all fits

together nicely in package???)

HELP!!!???

Thanks!

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

[Guest guest]

That brings another question to mind for

me. Do most of you do a lot of preventive visits/physicals? For

some reason, my pt’s rarely come in & say “I need an annual

physical.” Do you prompt the visit or do the pt’s? I

usually end up doing all of the preventive items piece meal as I go along (ie,

lets make sure you’ve had your colonoscopy, PSA, etc, ). Maybe I

need to push pt’s more towards an annual preventive visit.

BILLING - SURG

PROCEDURE and MED OFFICE

VISIT SAME DAY??

I have often billed for both in the same day but

unsure if they were both

being paid at my

prior clinic as I had no way to track those

numbers, just kept running from

patient to

patient without much understanding of the business

side. Now I am

interested.

Examples:

1) Removing a sebaceous cyst and also counseling

on cholesterol (gee, gotta

talk about

something besides the weather and may as well bill

for it if you do) so...

11401 - link to sebaceous

cyst

99213 - link to 272.0

high chol

2) During a physical you see a very suspicious

mole so you biopsy it

99385 - link to V72.31

99212 - link to nevus,

uncertain nature 238.2

11100 - (biopsy) link to

238.2

(I am often confused on physicals

about whether to link to anything other

than V70, or

V72.31 because then you have to

put another E/M code which inflates the

patient's

bill beyond the physical exam, but I

do feel like a biopsy should be

charged if done, BUT

then don't ya have to indicate the

suspicios mole under a 99212ish code so

it all fits

together nicely in package???)

HELP!!!???

Thanks!

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

[Guest guest]

Boy, I totally agree. Can't get any kind of preventative code and e/m visit

paid in RI thru bc/bs or united here, these fees are bundled (didn't aetna

and cigna lose a class action law suit around the issue of bundling claims,

was it e/m visits + minor surgical procedures?) The funny thing was, when I

first started, I was able to get a PE + e/m visit paid thru bc/bs of

pennsylvania, has never happened again since, but it raised my expectations

for a while. I saw in the instructions for the welcome to medicare physical

exam that e/m visits with the -25 modifier WERE allowed, I'm going to try

that this week.

Lynn Ho

>

>Reply-To:

>To: < >

>Subject: RE: BILLING - SURG PROCEDURE and MED

>OFFICE VISIT SAME DAY??

>Date: Thu, 12 Jan 2006 08:36:03 -0500

>

>You must have better companies there. I tried that several times & it was

>never paid. I'm starting to think I need to pick a better state than Ohio,

>based on others practice stories here.

>

>

>

>

>

>

>

[Guest guest]

Boy, I totally agree. Can't get any kind of preventative code and e/m visit

paid in RI thru bc/bs or united here, these fees are bundled (didn't aetna

and cigna lose a class action law suit around the issue of bundling claims,

was it e/m visits + minor surgical procedures?) The funny thing was, when I

first started, I was able to get a PE + e/m visit paid thru bc/bs of

pennsylvania, has never happened again since, but it raised my expectations

for a while. I saw in the instructions for the welcome to medicare physical

exam that e/m visits with the -25 modifier WERE allowed, I'm going to try

that this week.

Lynn Ho

>

>Reply-To:

>To: < >

>Subject: RE: BILLING - SURG PROCEDURE and MED

>OFFICE VISIT SAME DAY??

>Date: Thu, 12 Jan 2006 08:36:03 -0500

>

>You must have better companies there. I tried that several times & it was

>never paid. I'm starting to think I need to pick a better state than Ohio,

>based on others practice stories here.

>

>

>

>

>

>

>

[Guest guest]

Of course, Anthem BCBS just lost the same class action against them & now

they are already back to the same old tricks. Here in parts of Ohio they

are " blending " payment for codes 99213/99214 & 99203/99204 into one dollar

amount each. How is that not a breech of their settlement agreement?

Believe it or not, they claim their legal dept. cleared it first & no one

has challenged it legally thus far. By the way, we don't accept Anthem BCBS

for these same types of reasons. Ironically, pt's can't understand why we

don't take their " great " insurance as they call it.

RE: BILLING - SURG PROCEDURE and MED

>OFFICE VISIT SAME DAY??

>Date: Thu, 12 Jan 2006 08:36:03 -0500

>

>You must have better companies there. I tried that several times & it was

>never paid. I'm starting to think I need to pick a better state than Ohio,

>based on others practice stories here.

>

>

>

>

>

>

>

[Guest guest]

Of course, Anthem BCBS just lost the same class action against them & now

they are already back to the same old tricks. Here in parts of Ohio they

are " blending " payment for codes 99213/99214 & 99203/99204 into one dollar

amount each. How is that not a breech of their settlement agreement?

Believe it or not, they claim their legal dept. cleared it first & no one

has challenged it legally thus far. By the way, we don't accept Anthem BCBS

for these same types of reasons. Ironically, pt's can't understand why we

don't take their " great " insurance as they call it.

RE: BILLING - SURG PROCEDURE and MED

>OFFICE VISIT SAME DAY??

>Date: Thu, 12 Jan 2006 08:36:03 -0500

>

>You must have better companies there. I tried that several times & it was

>never paid. I'm starting to think I need to pick a better state than Ohio,

>based on others practice stories here.

>

>

>

>

>

>

>

[Guest guest]

I am new to your listserv. Hello.

Anyway, I recently called Medicare because they they reimbursed zero

for my AK freezing that I had done concurrent with an office visit.

Our conversation went as follows: Medicare: " I'm sorry, but you have

to code these on separate days of service. " ME: " So I have this

crippled little old lady sitting here on my exam table, discussing

her incontinence and I see a potential precancerous lesion on her

nose that I can treat with my liquid nitrogen BUT I'm to tell her,

sorry she has to come back tomorrow to get that done so I can be

paid by Medicare " ?! Medicare (sounding sheepish): " Gee,that does

sound a bit sad, but unfortunately I'm sorry, you have to code these

on separate days of service. "

This is my reality! (I wrote it off) Next time, I'll be more

creative.

>

> I have often billed for both in the same day but unsure if they

were both being paid at my

> prior clinic as I had no way to track those numbers, just kept

running from patient to

> patient without much understanding of the business side. Now I am

interested.

>

> Examples:

>

> 1) Removing a sebaceous cyst and also counseling on cholesterol

(gee, gotta talk about

> something besides the weather and may as well bill for it if you

do) so...

>

> 11401 - link to sebaceous cyst

> 99213 - link to 272.0 high chol

>

> 2) During a physical you see a very suspicious mole so you biopsy

it

>

> 99385 - link to V72.31

> 99212 - link to nevus, uncertain nature 238.2

> 11100 - (biopsy) link to 238.2

>

> (I am often confused on physicals about whether to link to

anything other than V70, or

> V72.31 because then you have to put another E/M code which

inflates the patient's

> bill beyond the physical exam, but I do feel like a biopsy

should be charged if done, BUT

> then don't ya have to indicate the suspicios mole under a

99212ish code so it all fits

> together nicely in package???)

>

>

> HELP!!!???

>

>

> Thanks!

>

> Pamela

>

>

> Pamela Wible, MD

> Family & Community Medicine, LLC

> 3575 st. #220

> Eugene, OR 97405

>

> roxywible@c...

>

[Guest guest]

I am new to your listserv. Hello.

Anyway, I recently called Medicare because they they reimbursed zero

for my AK freezing that I had done concurrent with an office visit.

Our conversation went as follows: Medicare: " I'm sorry, but you have

to code these on separate days of service. " ME: " So I have this

crippled little old lady sitting here on my exam table, discussing

her incontinence and I see a potential precancerous lesion on her

nose that I can treat with my liquid nitrogen BUT I'm to tell her,

sorry she has to come back tomorrow to get that done so I can be

paid by Medicare " ?! Medicare (sounding sheepish): " Gee,that does

sound a bit sad, but unfortunately I'm sorry, you have to code these

on separate days of service. "

This is my reality! (I wrote it off) Next time, I'll be more

creative.

>

> I have often billed for both in the same day but unsure if they

were both being paid at my

> prior clinic as I had no way to track those numbers, just kept

running from patient to

> patient without much understanding of the business side. Now I am

interested.

>

> Examples:

>

> 1) Removing a sebaceous cyst and also counseling on cholesterol

(gee, gotta talk about

> something besides the weather and may as well bill for it if you

do) so...

>

> 11401 - link to sebaceous cyst

> 99213 - link to 272.0 high chol

>

> 2) During a physical you see a very suspicious mole so you biopsy

it

>

> 99385 - link to V72.31

> 99212 - link to nevus, uncertain nature 238.2

> 11100 - (biopsy) link to 238.2

>

> (I am often confused on physicals about whether to link to

anything other than V70, or

> V72.31 because then you have to put another E/M code which

inflates the patient's

> bill beyond the physical exam, but I do feel like a biopsy

should be charged if done, BUT

> then don't ya have to indicate the suspicios mole under a

99212ish code so it all fits

> together nicely in package???)

>

>

> HELP!!!???

>

>

> Thanks!

>

> Pamela

>

>

> Pamela Wible, MD

> Family & Community Medicine, LLC

> 3575 st. #220

> Eugene, OR 97405

>

> roxywible@c...

>

[Guest guest]

Now those I do get paid for on the same date of service as an E/M. Did you

add the -25 modifier to the E/M code? If not, they will deny it & are not

obligated to tell you that were supposed to use that modifier (ie, they will

just " play dumb " ).

Re: BILLING - SURG PROCEDURE and MED OFFICE

VISIT SAME DAY??

I am new to your listserv. Hello.

Anyway, I recently called Medicare because they they reimbursed zero

for my AK freezing that I had done concurrent with an office visit.

Our conversation went as follows: Medicare: " I'm sorry, but you have

to code these on separate days of service. " ME: " So I have this

crippled little old lady sitting here on my exam table, discussing

her incontinence and I see a potential precancerous lesion on her

nose that I can treat with my liquid nitrogen BUT I'm to tell her,

sorry she has to come back tomorrow to get that done so I can be

paid by Medicare " ?! Medicare (sounding sheepish): " Gee,that does

sound a bit sad, but unfortunately I'm sorry, you have to code these

on separate days of service. "

This is my reality! (I wrote it off) Next time, I'll be more

creative.

>

> I have often billed for both in the same day but unsure if they

were both being paid at my

> prior clinic as I had no way to track those numbers, just kept

running from patient to

> patient without much understanding of the business side. Now I am

interested.

>

> Examples:

>

> 1) Removing a sebaceous cyst and also counseling on cholesterol

(gee, gotta talk about

> something besides the weather and may as well bill for it if you

do) so...

>

> 11401 - link to sebaceous cyst

> 99213 - link to 272.0 high chol

>

> 2) During a physical you see a very suspicious mole so you biopsy

it

>

> 99385 - link to V72.31

> 99212 - link to nevus, uncertain nature 238.2

> 11100 - (biopsy) link to 238.2

>

> (I am often confused on physicals about whether to link to

anything other than V70, or

> V72.31 because then you have to put another E/M code which

inflates the patient's

> bill beyond the physical exam, but I do feel like a biopsy

should be charged if done, BUT

> then don't ya have to indicate the suspicios mole under a

99212ish code so it all fits

> together nicely in package???)

>

>

> HELP!!!???

>

>

> Thanks!

>

> Pamela

>

>

> Pamela Wible, MD

> Family & Community Medicine, LLC

> 3575 st. #220

> Eugene, OR 97405

>

> roxywible@c...

>

[Guest guest]

Now those I do get paid for on the same date of service as an E/M. Did you

add the -25 modifier to the E/M code? If not, they will deny it & are not

obligated to tell you that were supposed to use that modifier (ie, they will

just " play dumb " ).

Re: BILLING - SURG PROCEDURE and MED OFFICE

VISIT SAME DAY??

I am new to your listserv. Hello.

Anyway, I recently called Medicare because they they reimbursed zero

for my AK freezing that I had done concurrent with an office visit.

Our conversation went as follows: Medicare: " I'm sorry, but you have

to code these on separate days of service. " ME: " So I have this

crippled little old lady sitting here on my exam table, discussing

her incontinence and I see a potential precancerous lesion on her

nose that I can treat with my liquid nitrogen BUT I'm to tell her,

sorry she has to come back tomorrow to get that done so I can be

paid by Medicare " ?! Medicare (sounding sheepish): " Gee,that does

sound a bit sad, but unfortunately I'm sorry, you have to code these

on separate days of service. "

This is my reality! (I wrote it off) Next time, I'll be more

creative.

>

> I have often billed for both in the same day but unsure if they

were both being paid at my

> prior clinic as I had no way to track those numbers, just kept

running from patient to

> patient without much understanding of the business side. Now I am

interested.

>

> Examples:

>

> 1) Removing a sebaceous cyst and also counseling on cholesterol

(gee, gotta talk about

> something besides the weather and may as well bill for it if you

do) so...

>

> 11401 - link to sebaceous cyst

> 99213 - link to 272.0 high chol

>

> 2) During a physical you see a very suspicious mole so you biopsy

it

>

> 99385 - link to V72.31

> 99212 - link to nevus, uncertain nature 238.2

> 11100 - (biopsy) link to 238.2

>

> (I am often confused on physicals about whether to link to

anything other than V70, or

> V72.31 because then you have to put another E/M code which

inflates the patient's

> bill beyond the physical exam, but I do feel like a biopsy

should be charged if done, BUT

> then don't ya have to indicate the suspicios mole under a

99212ish code so it all fits

> together nicely in package???)

>

>

> HELP!!!???

>

>

> Thanks!

>

> Pamela

>

>

> Pamela Wible, MD

> Family & Community Medicine, LLC

> 3575 st. #220

> Eugene, OR 97405

>

> roxywible@c...

>

[Guest guest]

RE Preventative "checkup" vs directed examination.

A number of times, pts will come in and say they "want a checkup" but really need a few things addressed. Had one today, who presented with snoring, but as we got into it, has a history of high cholesterol from annual work PE noone really follows up on. We made visit a high cholesterol, possible sleep apnea and a couple other things. Really didn't get to the "well care" part of things.

Also, we've been checking eligibility of "well care" coverage-- thankfully, 2 of the main insurers we can check online availability, the others we have to call. Typically, we call after the first appt, as I do everything possible to "avoid" the "well care" on the first visit, because, truly, lots of pts DO NOT HAVE well care coverage, even when they THINK they do. You MUST check the benefit, and can.

We also get coverage for E & M and well care same day; some insurers ask for 2 copays (yuk) and we've fought this issue of the 2 copays so pts don't think we're getting them for an unexpected copay. I also find we DO get paid for those who HAVE the benefit.

-- check the policy each pt has; then, if the pt does NOT have the benefit, you indeed may not want to schedule the separate "checkup." Some insurances, though, are very specific, and insist on "1 visit, EITHER well care OR E & M/problem specific coverage." While I think this is a rotten policy, I end up bringing the pt back for it. Realize that of these I've seen, the "well care" benefit is a dollar amount "up to" a certain amount per calendar year, as the insurer is only covering what THEY think is well care, but it does work out.

I also annotate in my note (every note) when the "last" well care was completed, so I'll catch them weekly.

Hope this helps.

Dr Matt Levin

FP in low overhead ($10K/month, 2.5 FTE) practice

Pittsburgh, PA

RE: BILLING - SURG PROCEDURE and MED OFFICE VISIT SAME DAY??

That brings another question to mind for me. Do most of you do a lot of preventive visits/physicals? For some reason, my pt’s rarely come in & say “I need an annual physical.” Do you prompt the visit or do the pt’s? I usually end up doing all of the preventive items piece meal as I go along (ie, lets make sure you’ve had your colonoscopy, PSA, etc, ). Maybe I need to push pt’s more towards an annual preventive visit.

-----Original Message-----From: [mailto: ] On Behalf Of Annie SkaggsSent: Wednesday, January 11, 2006 11:48 PMTo: Subject: RE: BILLING - SURG PROCEDURE and MED OFFICE VISIT SAME DAY??

My billing service said the same thing, but I pitched a fit to try it and so far all but Anthem are paying the preventive code plus the 99213 or 4-25.

Annie

-----Original Message-----From: [mailto: ] On Behalf Of Brock DOSent: Wednesday, January 11, 2006 2:35 PMTo: Subject: RE: BILLING - SURG PROCEDURE and MED OFFICE VISIT SAME DAY??

I have never seen any insurance that pays both a preventive visit & aproblem-focused E/M in the same visit. That is one of those things thatcoding gurus like to talk about but I've never had both covered together(even using the -25 modifier, etc). Otherwise, yes definitely code the E/M+ cholesterol discussion + cyst excision together (w/ -25) & they should bepaid.-----Original Message-----From: [mailto: ] On Behalf Of roxywibleSent: Wednesday, January 11, 2006 1:28 PMTo: Subject: BILLING - SURG PROCEDURE and MED OFFICEVISIT SAME DAY??I have often billed for both in the same day but unsure if they were bothbeing paid at my prior clinic as I had no way to track those numbers, just kept running frompatient to patient without much understanding of the business side. Now I aminterested.Examples: 1) Removing a sebaceous cyst and also counseling on cholesterol (gee, gottatalk about something besides the weather and may as well bill for it if you do) so... 11401 - link to sebaceous cyst 99213 - link to 272.0 high chol2) During a physical you see a very suspicious mole so you biopsy it 99385 - link to V72.31 99212 - link to nevus, uncertain nature 238.2 11100 - (biopsy) link to 238.2 (I am often confused on physicals about whether to link to anything otherthan V70, or V72.31 because then you have to put another E/M code which inflates thepatient's bill beyond the physical exam, but I do feel like a biopsy should becharged if done, BUT then don't ya have to indicate the suspicios mole under a 99212ish code soit all fits together nicely in package???)HELP!!!???Thanks!PamelaPamela Wible, MDFamily & Community Medicine, LLC3575 st. #220 Eugene, OR 97405roxywible@...

[Guest guest]

RE Preventative "checkup" vs directed examination.

A number of times, pts will come in and say they "want a checkup" but really need a few things addressed. Had one today, who presented with snoring, but as we got into it, has a history of high cholesterol from annual work PE noone really follows up on. We made visit a high cholesterol, possible sleep apnea and a couple other things. Really didn't get to the "well care" part of things.

Also, we've been checking eligibility of "well care" coverage-- thankfully, 2 of the main insurers we can check online availability, the others we have to call. Typically, we call after the first appt, as I do everything possible to "avoid" the "well care" on the first visit, because, truly, lots of pts DO NOT HAVE well care coverage, even when they THINK they do. You MUST check the benefit, and can.

We also get coverage for E & M and well care same day; some insurers ask for 2 copays (yuk) and we've fought this issue of the 2 copays so pts don't think we're getting them for an unexpected copay. I also find we DO get paid for those who HAVE the benefit.

-- check the policy each pt has; then, if the pt does NOT have the benefit, you indeed may not want to schedule the separate "checkup." Some insurances, though, are very specific, and insist on "1 visit, EITHER well care OR E & M/problem specific coverage." While I think this is a rotten policy, I end up bringing the pt back for it. Realize that of these I've seen, the "well care" benefit is a dollar amount "up to" a certain amount per calendar year, as the insurer is only covering what THEY think is well care, but it does work out.

I also annotate in my note (every note) when the "last" well care was completed, so I'll catch them weekly.

Hope this helps.

Dr Matt Levin

FP in low overhead ($10K/month, 2.5 FTE) practice

Pittsburgh, PA

RE: BILLING - SURG PROCEDURE and MED OFFICE VISIT SAME DAY??

That brings another question to mind for me. Do most of you do a lot of preventive visits/physicals? For some reason, my pt’s rarely come in & say “I need an annual physical.” Do you prompt the visit or do the pt’s? I usually end up doing all of the preventive items piece meal as I go along (ie, lets make sure you’ve had your colonoscopy, PSA, etc, ). Maybe I need to push pt’s more towards an annual preventive visit.

-----Original Message-----From: [mailto: ] On Behalf Of Annie SkaggsSent: Wednesday, January 11, 2006 11:48 PMTo: Subject: RE: BILLING - SURG PROCEDURE and MED OFFICE VISIT SAME DAY??

My billing service said the same thing, but I pitched a fit to try it and so far all but Anthem are paying the preventive code plus the 99213 or 4-25.

Annie

-----Original Message-----From: [mailto: ] On Behalf Of Brock DOSent: Wednesday, January 11, 2006 2:35 PMTo: Subject: RE: BILLING - SURG PROCEDURE and MED OFFICE VISIT SAME DAY??

I have never seen any insurance that pays both a preventive visit & aproblem-focused E/M in the same visit. That is one of those things thatcoding gurus like to talk about but I've never had both covered together(even using the -25 modifier, etc). Otherwise, yes definitely code the E/M+ cholesterol discussion + cyst excision together (w/ -25) & they should bepaid.-----Original Message-----From: [mailto: ] On Behalf Of roxywibleSent: Wednesday, January 11, 2006 1:28 PMTo: Subject: BILLING - SURG PROCEDURE and MED OFFICEVISIT SAME DAY??I have often billed for both in the same day but unsure if they were bothbeing paid at my prior clinic as I had no way to track those numbers, just kept running frompatient to patient without much understanding of the business side. Now I aminterested.Examples: 1) Removing a sebaceous cyst and also counseling on cholesterol (gee, gottatalk about something besides the weather and may as well bill for it if you do) so... 11401 - link to sebaceous cyst 99213 - link to 272.0 high chol2) During a physical you see a very suspicious mole so you biopsy it 99385 - link to V72.31 99212 - link to nevus, uncertain nature 238.2 11100 - (biopsy) link to 238.2 (I am often confused on physicals about whether to link to anything otherthan V70, or V72.31 because then you have to put another E/M code which inflates thepatient's bill beyond the physical exam, but I do feel like a biopsy should becharged if done, BUT then don't ya have to indicate the suspicios mole under a 99212ish code soit all fits together nicely in package???)HELP!!!???Thanks!PamelaPamela Wible, MDFamily & Community Medicine, LLC3575 st. #220 Eugene, OR 97405roxywible@...

[Guest guest]

Keep their feet to the fire! Have you signed up for the Practicemgt list on AAFP? Earl Carstenson

had assembled a collection of “bundling” letters to educate

patients about why they must come back for other problems if they are in for a

physical. Holler if you can’t

find them; I

think I can forward one of his posts.

Annie

BILLING - SURG

PROCEDURE and MED OFFICE

VISIT SAME DAY??

I have often billed for both in the same day but

unsure if they were both

being paid at my

prior clinic as I had no way to track those

numbers, just kept running from

patient to

patient without much understanding of the business

side. Now I am

interested.

Examples:

1) Removing a s! ebaceous cyst and also counseling

on cholesterol (gee, gotta

talk about

something besides the weather and may as well bill

for it if you do) so...

11401 - link to sebaceous

cyst

99213 - link to 272.0

high chol

2) During a physical you see a very suspicious

mole so you biopsy it

99385 - link to V72.31

99212 - link to nevus,

uncertain nature 238.2

11100 - (biopsy) link to

238.2

(I am often confused on physicals

about whether to link to anything other

than V70, or

V72.31 because then you have to

put another E/M code which inflates the

patient's

bill beyond the physical exam, but I

do feel like a biopsy should be

charged if done, BUT

then don't ya have to indicate the

suspicios mole under a 99212ish code so

it all fits

together nicely in package???)

HELP!!!???

Thanks!

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

[Guest guest]

Keep their feet to the fire! Have you signed up for the Practicemgt list on AAFP? Earl Carstenson

had assembled a collection of “bundling” letters to educate

patients about why they must come back for other problems if they are in for a

physical. Holler if you can’t

find them; I

think I can forward one of his posts.

Annie

BILLING - SURG

PROCEDURE and MED OFFICE

VISIT SAME DAY??

I have often billed for both in the same day but

unsure if they were both

being paid at my

prior clinic as I had no way to track those

numbers, just kept running from

patient to

patient without much understanding of the business

side. Now I am

interested.

Examples:

1) Removing a s! ebaceous cyst and also counseling

on cholesterol (gee, gotta

talk about

something besides the weather and may as well bill

for it if you do) so...

11401 - link to sebaceous

cyst

99213 - link to 272.0

high chol

2) During a physical you see a very suspicious

mole so you biopsy it

99385 - link to V72.31

99212 - link to nevus,

uncertain nature 238.2

11100 - (biopsy) link to

238.2

(I am often confused on physicals

about whether to link to anything other

than V70, or

V72.31 because then you have to

put another E/M code which inflates the

patient's

bill beyond the physical exam, but I

do feel like a biopsy should be

charged if done, BUT

then don't ya have to indicate the

suspicios mole under a 99212ish code so

it all fits

together nicely in package???)

HELP!!!???

Thanks!

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

[Guest guest]

I was on that AAFP list but it became too

much of a “downer” after a while. There was a lot of

pessimism & adversarial venting about insurances. When a few people

there were saying that they were coding upwards of 90% of their visits as

99205/99215 & were up in arms that they received warning letters from UHC,

I decided to leave the list (of course you are going to get a letter if you are

THAT much of a coding outlier, I agree with it in that case, UHC is still a

business after all!). However, at other times the list WAS helpful.

Maybe I will give it another try. Thanks. In the mean time, I will

keep educating my pt’s about these payment issues. Dr. Brady’s

website is a good example. He has some excellent short descriptive

paragraphs about things like bundling, insurance company pressures on doctors,

etc.

BILLING - SURG

PROCEDURE and MED OFFICE

VISIT SAME DAY??

I have often billed for both in the same day but

unsure if they were both

being paid at my

prior clinic as I had no way to track those

numbers, just kept running from

patient to

patient without much understanding of the business

side. Now I am

interested.

Examples:

1) Removing a s! ebaceous cyst and also counseling

on cholesterol (gee, gotta

talk about

something besides the weather and may as well bill

for it if you do) so...

11401 - link to sebaceous

cyst

99213 - link to 272.0

high chol

2) During a physical you see a very suspicious

mole so you biopsy it

99385 - link to V72.31

99212 - link to nevus,

uncertain nature 238.2

11100 - (biopsy) link to

238.2

(I am often confused on physicals

about whether to link to anything other

than V70, or

V72.31 because then you have to

put another E/M code which inflates the

patient's

bill beyond the physical exam, but I

do feel like a biopsy should be

charged if done, BUT

then don't ya have to indicate the

suspicios mole under a 99212ish code so

it all fits

together nicely in package???)

HELP!!!???

Thanks!

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

[Guest guest]

I was on that AAFP list but it became too

much of a “downer” after a while. There was a lot of

pessimism & adversarial venting about insurances. When a few people

there were saying that they were coding upwards of 90% of their visits as

99205/99215 & were up in arms that they received warning letters from UHC,

I decided to leave the list (of course you are going to get a letter if you are

THAT much of a coding outlier, I agree with it in that case, UHC is still a

business after all!). However, at other times the list WAS helpful.

Maybe I will give it another try. Thanks. In the mean time, I will

keep educating my pt’s about these payment issues. Dr. Brady’s

website is a good example. He has some excellent short descriptive

paragraphs about things like bundling, insurance company pressures on doctors,

etc.

BILLING - SURG

PROCEDURE and MED OFFICE

VISIT SAME DAY??

I have often billed for both in the same day but

unsure if they were both

being paid at my

prior clinic as I had no way to track those

numbers, just kept running from

patient to

patient without much understanding of the business

side. Now I am

interested.

Examples:

1) Removing a s! ebaceous cyst and also counseling

on cholesterol (gee, gotta

talk about

something besides the weather and may as well bill

for it if you do) so...

11401 - link to sebaceous

cyst

99213 - link to 272.0

high chol

2) During a physical you see a very suspicious

mole so you biopsy it

99385 - link to V72.31

99212 - link to nevus,

uncertain nature 238.2

11100 - (biopsy) link to

238.2

(I am often confused on physicals

about whether to link to anything other

than V70, or

V72.31 because then you have to

put another E/M code which inflates the

patient's

bill beyond the physical exam, but I

do feel like a biopsy should be

charged if done, BUT

then don't ya have to indicate the

suspicios mole under a 99212ish code so

it all fits

together nicely in package???)

HELP!!!???

Thanks!

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...