Many pediatricians are still getting denials when they report a well and sick visit on the same day. Carriers should be aware that Physicians’ Current Procedural Terminology (CPT®)guidelines indicate that in certain cases, it is appropriate to report a preventive medicine service code (99381–99397) in conjunction with an office or outpatient service code (99201–99215) on the same date of service.

According to the American Medical Association CPT guidelines, “If an abnormality(ies) is encountered or a preexisting problem is addressed in the process of performing a preventive medicine evaluation and management service, and if the problem/abnormality(ies) is significant enough to require additional work to perform the key components of a problem-oriented service, then the appropriate office/outpatient code should also be reported. Modifier -25 should be added to the office/outpatient code to indicate that a significant, separately identifiable evaluation and management service was provided by the same physician on...

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