Family medicine sees the highest volume of the specialties we work with, which means small coding habits compound fast. A visit level applied consistently but incorrectly costs the same amount on every encounter, and never denies.
The recurring judgement call is preventive versus problem-oriented. When both happen in one visit, both are billable, but only if the documentation separates them and the right modifier is applied.
What trips family medicine claims up
- Preventive and problem-oriented work split correctly when both happen
- Modifier {25} used where a significant separate service was documented
- Chronic care management time captured rather than absorbed
- Vaccine administration billed alongside the product, not instead of it
What we check before a claim goes out
- Preventive and problem-oriented work separated when both occur
- Modifier 25 used where a significant separate service is documented
- Vaccine administration billed alongside the product