Make every visit count

When scheduling appointments for sick visits or sports physicals (non-covered service), check to see if the patient is due for a preventive visit. If the patient is due, ask if they would like to complete the well-child visit with the sick visit or schedule at another time. This will help ensure a preventive visit gets scheduled as well as ensuring there is enough time blocked in the schedule for the visit type.

When a sick patient comes in and is due for a well child visit, document all the components of a well-child visit if time allows or schedule a well child visit while the member is in the office. Both procedure codes can be reported if the visit meets the documentation guidelines to support each service. Documentation must support that both services were provided in their entirety as significant and separately identifiable services. The problem-oriented E&M service should be submitted with the 25 modifier to indicate separate service occurred. This allows us to capture data for the well-child visit, and we will reimburse for both services.

Topics: Billing, Coding, Preventive care