Yes Virginia, You CAN Bill Both

June 8th, 2012

Yes, you CAN bill for a preventive and sick patient services on the same day!

Initially, CMS wanted preventive services to be billed on separate days from sick patient visits; but the final rule ALLOWS both to be billed. 

But be careful.  It is unlikely that you can bill a high level sick visit and a preventive service on the same day.  History and exam elements that are part of the preventive service CANNOT be double counted!  Thus, if the elements are part of the preventive service, they are NOT part of the sick patient service.

CPT says you can bill both well patient and sick patient on the same day IF the problem "is significant enough to require additional work to perform the key components of a problem-oriented E/M service." Append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the evaluation and management code.

Ideally the provider will document the visits separately.

NO CoPays or CoInsurance for Annual Wellness Visit

Under the Affordable Care Act, all insurance companies MUST provide an annual physical at no cost to the patient.  If you collect a copay for the annual physical, the patient will be owed a refund.

Tags: Modifiers, Preventive Services


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