Q: Can one appointment be considered both a physical and an office visit?
A: No, even though the provider may perform both services during the same appointment, these are billed as two distinct services. There will be a charge for the preventive physical and a separate charge for the problem portion of the visit.
If your preventive physical includes consultation or treatment for a specific condition, your provider is legally required to report additional medical services on your bill. The problem portion of the visit may result in additional costs to you.
Q: Why is it billed differently?
A: It’s billed differently to account for the additional work, expertise and time required for a combination visit (additional lab work, x-ray, referrals and/or prescription medications). It involves additional documentation as well.
Q: How often should my child have a well-check?
A: If your child is 3 years or older, they should have a well check once a year. For our recommended well-check schedule for younger children, visit our Well-Child website page.
Q: What is the policy of Cincinnati Children's?
A: Please be aware that a provider may bill an office visit (99212-99215) in addition to a previously scheduled preventative visit. Per CPT coding rules, the well child visit code applies only to preventive medical care but does not include any issues related to chronic diseases or acute illness.
Insurance companies process these claims according to their policy guidelines, and the patient may have a balance due for the unrelated office visit. If your child comes in for a well-child visit, but during the routine visit “an abnormality is encountered, or a preexisting condition is addressed,” the appropriate office E/M service will be coded in addition to the preventative code. Examples include patients with asthma and ADD/ADHD coming in for a well-check exam.
For more information
We’re here for you and your family every step of the way. If you have questions about your particular insurance, you can call our billing department at 513-336-6700. Check out our additional website Resources and follow us on Facebook.