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Medical & Coding Policies
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Printer Friendly Version Preventive Wellness Visits and Illness Visits on the Same Day
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.
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POLICY EXCEPTIONSNone
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POLICY GUIDELINESThe coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.
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POLICY HISTORY6/2009: Policy published4/12/2010: Clarification added to the policy to indicate that BCBSMS does not accept preventive wellness and illness visits on the same day. |
