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patient annual physical examination and the - 25 CPT code modifier

If a patient comes in for an annual physical examination (preventative visit) and also is seen for an additional illness or injury, how would you code the visit?

According to the CPT coding book, you can bill for both the preventive and problem-oriented visit. You would report the preventive visit first (99381– 99397), then the problem-oriented visit (99201–99215) with a -25 modifier (significant, separately identifiable E&M service by the same physician on the same day of the procedure or other service).

It is very important that you link the respective diagnosis to the procedure code. For example, if a 22 year old male comes in for a preventive visit and is treated for a migraine headache, the visit would be coded as such: 99395, V70.0· 99213-25, 307.81

Depending on the insurance plan, both visits may be paid. If your practice encounters this situation often, it is recommended that you contact your top insurance plans and inquire if both visits are reimbursable. This will allow you to notify the patient and make financial arrangements accordingly.

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