How to bill 99213 with 99395?
Asked by: Dr. Julius Kshlerin | Last update: June 30, 2025Score: 4.3/5 (30 votes)
Can an office visit and preventive visit be billed together?
CPT states that if a new or existing problem is assessed and managed at the time of the preventive visit, the physician should also bill a problem-oriented visit (an office visit) on the day of the preventive care.
How do you use modifier 25 with preventive visit?
Modifier 25 should be appended to the office or other outpatient visit code to indicate that a significant, separately identifiable E/M service was provided on the same date as the preventive medicine E/M service, and the appropriate preventive medicine E/M service is additionally reported without a modifier.
What is the billing guideline for 99395?
The 99395 CPT code is used to describe a preventive (well-patient) outpatient office visit for an established patient between the ages of 18 and 39.
Can you bill a procedure and office visit together?
Sometimes yes, sometimes no. The decision to perform a minor procedure is included in the payment for the procedure, unless a significant and separate E/M is needed, performed and documented. Watch this short video to learn more.
Medical Coding 99213 vs 99214 - MDM Medical Decision Making Explained
Can you bill 99213 and 99396 together?
In this case, you may submit codes for both a preventive service (such as 99396) and a regular office visit (such as 99213) by attaching -25 to the office-visit code.
What is the modifier for office visit and procedure same day?
Modifier 25 Description
The provider may need to indicate that on the day of a procedure was performed; the patient's condition required a significant, separately identifiable E&M service above and beyond the usual preoperative and post- operative care associated with the procedure.
What is the CPT code 99395 and 99213?
99395 – Preventive Service, est patient 18-39 years (Primary DX – Z00. 0 - annual exam) 99213 – Office Visit – Low level (Primary DX – E11. 9 – diabetes without complications)
How do I bill for annual gyn exam?
- Report appropriate Preventive E/M (9938X or 9939X)
- Report Pelvic exam Add-on (99459)
How do you bill a wellness visit?
The CPT codes for Annual Wellness Visits are G0438 for the initial visit and G0439 for subsequent visits. These codes are used to bill Medicare for comprehensive wellness assessments and personalized prevention plans.
Does 99213 need a modifier 25?
If the E/M is not bundled into the stress test, then the Cardiologist's coder can use modifier 25 to indicate that these two services were separate and significant: 99213-25, 93015.
How do you code a preventive visit?
CPT® codes 99381-99397 are used for comprehensive preventive evaluations that are age-specific, beginning with infancy and ranging through patients 65 years and older, for both new and established patients.
Does modifier 25 go on office visit or procedure?
Modifier 25 is used to signify that when a separate identifiable evaluation-and-management (E/M) service was performed, which can refer to two evaluation-and-management (E/M) services, or a procedure plus an E/M service.
Can I use modifier 25 on a preventive visit?
Beginning January 1, 2025, Medicare will allow payment for G2211 when the base E/M services is appended with modifier 25 and provided on the same date as an annual wellness visit, initial preventive physical examination, vaccine or Medicare preventive service.
Is 99213 preventive?
However, if you bill an additional office visit code (for example, 15 minute expanded problem visit code 99213 with modifier 25), this is NOT considered a preventive service, and may be subject to deductibles, copays or coinsurance.
What is the 33 modifier used for?
Current Procedural Terminology (CPT) modifier 33 can be used when billing for ACA-designated preventive services with a commercial payer. The addition of modifier 33 communicates to a commercial payer that a given service was provided as an ACA preventive service.
How do you bill a Pap smear with an office visit?
Summary of pap smear billing guidelines
If a clinician is reporting CPT® preventive medicine services, and also performing a screening pap smear report a code in 99381-99397 series and Q0091. Use G0101 and Q0091 for Medicare patients receiving a screening pelvic and breast exam and also a screening pap smear.
How to code a routine gynecological exam?
Encounter for gynecological examination (general) (routine) without abnormal findings. Z01. 419 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2025 edition of ICD-10-CM Z01.
What is the CPT code 99213?
CPT® code 99213: Established patient office visit, 20-29 minutes | American Medical Association.
What modifier is used for 99395?
Wiki - 99395 with modifier 25 | Medical Billing and Coding Forum - AAPC.
What documentation is required for 99213?
- Relevant documentation: To support the 99213 code, include pertinent information such as the reason for the visit, history of present illness, review of systems, physical examination, assessment, and plan of care.
Does 99213 need a modifier?
Modifiers may be necessary for CPT code 99213 under certain circumstances, such as when billing for telehealth services or when other procedures are performed on the same day (e.g. Modifier 25). The specific modifier depends on the situation and payer requirements.
Can 2 office visits be billed same day?
Yes, in some cases, you can bill two E&M (Evaluation and Management) codes for the same patient on the same day, but it depends on payer rules and documentation requirements.
When to use 59 or 51 modifier?
Modifier -51 would be attached because the biopsy is the lesser-valued procedure done at the same session, and modifier -59 would be attached to indicate that the biopsy, which is normally bundled with excision of the same lesion, was done on a separate lesion from the one that was excised.