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Preventive Medicine Service - Articles

AMA vs Medicare rules and the use of the PT modifier
May 22nd, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Be sure to review the specific payer policy you are submitting claims to. Medicare’s policy requires the use of a different code when a screening colonoscopy becomes a diagnostic procedure requiring you to bill with CPT code 00811 when treating a Medicare Beneficiary. The use of the PT modifier is ...

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Medicare Diabetes Prevention Program (MDPP) Expanded Model Information
December 12th, 2017 - Jared Staheli
Diabetes treatment places an ever-increasing strain on the resources of the U.S. healthcare system. CMS estimated that in 2016 alone, Medicare incurred an additional $42 billion in costs due to the number of beneficiaries with diabetes. The best way to keep these costs down in the future is by preventing ...
Sports Physicals
July 27th, 2015 - Codapedia Editor
Sports or camp or college physicals are exams requested by a parent or patient as a screening prior to going to camp or college or playing a sport. They vary in their scope. If the patient presents for a well child visit, and also needs their camp physical filled out, it is pretty easy. Perform...
Preventive medicine and office visit, same day
June 1st, 2015 - Codapedia Editor
Can I use modifier 25 on an E/M service on the same day as a preventive medicine exam Let’s review what a preventive medicine service is, in order to answer that question. Preventive medicine services are: • The description given by CPT® for “annual physicals” •...
All About Screening and Diagnostic Mammograms
March 17th, 2015 - George Lawson
When billing for mammograms, documentation must include the purpose and the result of the procedure. Two major purposes of mammogram are diagnostic and screening. It can also be used mammography to guide other procedures. Tip 1: Confirm the Purpose Determine the purpose of the procedure; i.e....
Preventive medicine service and office visit on the same day
January 30th, 2015 - Codapedia Editor
Modifier 25 for Preventive medicine service and office visits The CPT® book describes modifier 25 as the modifier to be used on an E/M service when "a Significant, Separately Identifiable Evaluation and Management Service” is performed by the same physician on the same day of the...
Flu vaccine code changes coming in 2014
January 30th, 2014 - Scott Kraft
Prepare now for a handful of changes coming to the way you code for influenza vaccinations in 2014. Getting paid successfully, however, may require you to hold onto some claims for longer than you would ordinarily like. CMS has directed the Medicare Administrative Contractors (MACs) to pay for...
Wellness visits for Medicare patients
November 18th, 2013 - Codapedia Editor
Dec 20, 2010 Added Medicare's MLN Matters article as a resource. Hold the champagne--it's true that Health Care Reform added an annual "wellness"visit for every beneficiary, but it's not what you or your doctors think of as an annual exam. In fact, it's has more in common with the...
Influenza vaccine payments amounts released for 2013-2014
September 18th, 2013 - Scott Kraft
CMS has released the coding and payment information for the 2013-2014 flu vaccine season. As flu season kicks into overdrive, it seems like a good time to review payment rules for the flu shot. Most insurance payers will cover one flu shot per flu season. The Affordable Care Act (ACA) requires...
Medicare Wellness Visits--update
April 24th, 2013 - Codapedia Editor
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September 10th, 2009 - Codapedia Editor
Colonoscopy Screening versus diagnostic—Medicare patients Medicare develops HCPCS codes for some preventive medicine services when it wants to differentiate between a diagnostic test (which has a CPT® code) and a screening test. Colonoscopy is a good example. There are a series of...
G0101 Pelvic and breast exam
July 6th, 2009 - Codapedia Editor
Medicare does not pay for routine physical exams annually for patients--a sore spot for Primary Care Providers and Medicare beneficiaries alike. They do pay for an initial Welcome to Medicare visit. (See the Codapedia article about that topic.) Medicare does pay for a screening pelvic and breast...
How do I bill for a PAP smear?
April 22nd, 2009 - Codapedia Editor
Physicians often ask what codes to use in order to bill for a pap smear provided during a preventive medicine service or other E/M service. The only CPT® codes for pap smears are for Pathologists, for the physician interpretation of the cytology specimen. So, what does the GYN or primary care...
How to bill for Well Woman Exams (WWE)
April 15th, 2009 - Charlene Burgett
Well Woman Exam Coding There are options for billing pelvic exams and Pap smears for non-Medicare payers, albeit inconsistently by health plan. Some health plans will pay G0101, Q0091, S0610 and/or S0612. Some will pay one or another, some will pay a combination of two, others will pay certain...
Preventive Medicine Services for Medicare Patients
April 10th, 2009 - Codapedia Editor
The most widely known fact about Medicare and preventive medicine is that fee-for-service Medicare does not cover an annual physical exam. This is because in its beginning, Medicare was prohibited from paying for routine services. Over the years, Congress has mandated the payment of some screening...
Screening Diabetes tests for Medicare patinets
March 31st, 2009 - Codapedia Editor
The Medicare Modernization Act of 2003 added a benefit for Medicare patients for services provided after Jan 1, 2005. Medicare added coverage for screening Medicare patients for diabetes, if the patient has an individual risk for diabetes. There are diagnosis and frequency limitations. The...
Visual Acuity Screening
March 12th, 2009 - Codapedia Editor
Many physician practices are denied by third party payers when billing for a visual acuity test with a well child visit. The code for visual acuity testing is 99173. See the CPT® book for a complete definition of this code. This is a screening test of visual acuity, quantitative, bilateral,...
Billing for a breast exam
March 9th, 2009 - Codapedia Editor
Sometimes, a patient presents only for a breast exam, perhaps prior to a mammogram. Is that a separately billable service? Newly found lump: A patient who presents with a newly discovered lump and presents to the office can be billed with new or established patient visit codes (depending on the...
Can prolonged services be added to preventive medicine codes?
March 9th, 2009 - Codapedia Editor
There are two sets of prolonged services codes, one set for face-to-face additional time spent with the patient in the office or hospital, and one set for non-face-to-face time. Non-face-to-face time is typically not paid by most insurers. In 2009, CPT® changes its description of these...
AAA screening
March 2nd, 2009 - Codapedia Editor
Medicare allows screening for Abdominal Aortic Aneurysm in very limited situations. The screening must be ordered as part of the patient's Welcome to Medicare visit (Initial Preventive Physical Exam). That limits the screening to newly enrolled Medicare patients. If the patient has not had the...
Welcome to Medicare Visit
January 29th, 2009 - Codapedia Editor
Welcome to Medicare Initial Preventive Physical Examination (IPPE) A new benefit under the Medicare Modernization Act Effective date 1-1-05, changes for 2009 Eligibility: Any Medicare beneficiary who enrolls in Medicare on or after January 1, 2005 Time limits: Eligible for benefit in the...

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