can cpt 99213E&M Low and 99396 est patient phys (preventive) both on one visit

can cpt 99213 E&M Low and 99396 est patient phys (preventive) both be billed on one and the same visit?

during the preventive exam, no suspected illness or injury was discussed, involved or evaluated. no diagnosis or treament was considered or recommended by the physician.

the treatment is commercial insurance coverage, not medicare.

Thanks

E/m

I would not bill an E/M 99213 unless a significant problem was found and managed

but...you gotta think there is a reason she wanted to use both codes

you can bill it and many insurers pay if the doc fixes her documentation to reflect the work she actually did. Like a diabetic, hypertensive patient in for a yearly physical has a BP of 160/100 and a glucose of 200. You are addressing the health maint issues but also doing significant work on the 401.1 and 250.02. If you document the separation in the HPI and the MDM sections, and link the codes properly you can bill for both.

e/m billed with preventive

I understand the example you cited, but none of my indicators in the preventive exam were off trend and are within acceptable ranges or observations. The only on-going condition I have is vitiligo which wasn't discussed and wasn;t/isn;t treated.

Question

I do not see anything suggesting a chronic condition was also managed?
Topic:
can cpt 99213E&M Low and 99396 est patient phys (preventive) both on one visit

- Message:
can cpt 99213 E&M Low and 99396 est patient phys (preventive) both be billed on one and the same visit?

during the preventive exam, no suspected illness or injury was discussed, involved or evaluated. no diagnosis or treament was considered or recommended by the physician.

the treatment is commercial insurance coverage, not medicare.

E/M & Preventive

Should not bill both on same visit unless there is separate diagnosis. If separate diagnosis is there, we can bill separately with mod 25 for E/M. Otherwise we should not bill for both E/M & Preventive for any insurance.

E/M with preventive

When I audit these, I look at:

Patient's underlying conditions: are there any? what severity? Actively being managed?

HPI: "patient feeling well, no complaints" doesn't get an E/M. Are symptoms documented? The status of chronic diseases?

Exam: any unexpected, abnormal findings?

A/P: change in treatment, diagnostic tests, are more likely to require a visit. "all well, no change, get your colonoscopy" less likely to need an E/M.

It's gray. Read the section at the start of the preventive medicine service in the CPT book.

Finally: here's an article:

http://codapedia.com/-article_63_.cfm