CODING & DOCUMENTATION

 

Fam Pract Manag. 2021 Nov-Dec;28(6):32.

Author disclosure: no relevant financial affiliations.

TWO VISITS WITH THE SAME PATIENT ON THE SAME DATE

Q

I saw the same patient twice on the same date. The first visit was follow-up for chronic conditions. The second was to evaluate the patient for a concussion after an accident. My coder said adding modifier 25 to the code for the second visit should have resulted in payment for each service, but the charge for the second visit was denied. Is there another way to bill for these services?

A

No. Two distinct visits on the same day by the same physician (or physicians of the same specialty and group practice) for different problems are billed separately with modifier 25, as your coder instructed. However, some payers will deny the second visit initially and require an appeal that provides evidence of the distinct nature of the two encounters before allowing payment. Based on the description of events, you should appeal.

SCREENING FOR PREDIABETES

Q

The U.S. Preventive Services Task Force has lowered the recommended screening age for prediabetes and type 2 diabetes in patients who are overweight or obese. Is the screening now a covered preventive benefit for patients age 35–39 who are overweight or obese?

A

Yes. The task force gave the recommendation a “B” rating. That qualifies the screening for coverage with no out-of-pocket expense to patients covered by Medicare or health plans that are required to provide 100% coverage for recommended preventive services. However, it is worth verifying that your payers have updated their claims edits to pay for screening in patients under 40.

Per the recommendation, a fasting plasma glucose level, an A1C level, or an oral glucose tolerance test are indicated to screen for abnormal glucose. Physicians should document and assign diagnosis codes indicating patients are overweight or obese in addition to Z13.1 (Encounter for screening for diabetes

ABOUT THE AUTHOR

Cindy Hughes is an independent consulting editor based in El Dorado, Kan., and a contributing editor to FPM.

Author disclosure: no relevant financial affiliations.

WE WANT TO HEAR FROM YOU

Send questions and comments to fpmedit@aafp.org, or add your comments below. While this department attempts to provide accurate information, some payers may not accept the advice given. Refer to the current CPT and ICD-10 coding manuals and payer policies.

 
 

Copyright © 2021 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact fpmserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

MOST RECENT ISSUE


Jan-Feb 2022

Access the latest issue
of FPM journal

Read the Issue


FPM E-Newsletter

Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights."

Sign Up Now