Not uncommonly, when a child comes in for a check-up and has another presenting problem that is dealt with on the same day, the doctor codes an additional charge. One charge is considered the preventative medicine service (the well check), and the other is a problem-oriented service (problem visit).
For example, you present for your child’s check-up and ask about a persistent rash he’s had for several weeks. The doctor will perform all necessary well child exam protocols, including growth, development, and administering vaccines, as well as a problem-oriented exam of the rash, including any necessary prescriptions.
Or your child shows up for her scheduled well visit but happens to have a fever and a sore throat that day. The same guidelines would apply for any other abnormality or preexisting problem encountered at the well child exam.
These types of visits are always coded as two separate encounters, well-child and problem visit. When preventative care became covered without co-pays or deductibles, however, many patients began wondering why they had to pay for the well-child visit. The extra cost often includes a co-pay or payment toward the deductible for the “sick” part of the exam, even on the same day of service as the preventative care. The documentation and billing for these two exams must be filed separately, otherwise it would be considered insurance fraud on our part.
Unfortunately, because of your insurer’s payment policy, in some cases we may have to complete your wellness care and your illness care in two separate visits to allow appropriate billing. Your doctor may also decide that a non-urgent complaint brought up at a well visit would be more effectively managed at a separate visit. We will always attempt to address this at the time you check-in for the visit, but it is still your responsibility to notify us if you do not wish to have any extra charges applied.