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POLICYAccording to CPT coding guidelines, if an abnormality is encountered or a preexisting problem addressed in the process of performing the preventive medicine E/M service that is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate office/outpatient code (99201-99215) should be reported in addition to the appropriate code for the preventive E/M service. The problem of abnormality encountered must require additional work and the performance of the key components of a problem-oriented E/M service (preventive medicine and problem-oriented visit) in order for the two E/M services to be reported on the same day. If a physician encounters an insignificant or trivial problem/abnormality, in the process of performing the preventive medicine E/M service, that does not require additional work and the performance of the key components of a problem-oriented E/M service, then this should not be reported separately.
Blue Cross & Blue Shield of Mississippi currently does not accept or reimburse separately for a preventive medicine visits and an illness visit on the same day.
POLICY GUIDELINESThe coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.
POLICY HISTORY6/2009: Policy published
4/12/2010: Clarification added to the policy to indicate that BCBSMS does not accept preventive wellness and illness visits on the same day.