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Family Practice Billing Services

Family Practice billing and coding services encompass claims processing for a wide range of medical diagnoses and treatments delivered by primary care physicians. Family medicine is one of the broadest specialties, dealing with patients of all ages and various health conditions, making billing especially complex.

Managing revenue cycles in Family Practice requires handling multiple payers, accurately assigning codes for preventive care, chronic disease management, wellness visits, and urgent care. Errors in coding or documentation can result in delayed or denied payments.

At MBW RCM, we understand the intricacies of Family Practice billing. Our team specializes in clean claim submission, payer-specific coding, and denial resolution. We ensure optimized reimbursements while providers focus on patient care.

CPT & ICD Coding for Family Practice

Accurate CPT and ICD-10 coding is critical for capturing the full scope of services provided in a Family Practice. From chronic disease management to preventive screenings and urgent visits, selecting the correct codes ensures timely and complete reimbursement.

Common CPT Codes Used:

• 99202–99215 – Evaluation and Management (E/M) codes for new and established office or outpatient visits, based on medical decision-making or time.

• 99381–99397 – Preventive visit codes for new and established patients, often used during annual physicals and wellness checks.

• 99495–99496 – Transitional care management (TCM) services following a patient’s discharge from a hospital or skilled nursing facility.

Common ICD-10 Code Ranges:

• E00–E89 – Endocrine, nutritional, and metabolic diseases, including diabetes and thyroid disorders commonly managed in primary care.

• I10–I16 – Hypertensive diseases, encompassing essential hypertension and secondary hypertension conditions.

• J00–J99 – Respiratory diseases such as asthma, bronchitis, and upper respiratory infections frequently seen in outpatient visits.

• R00–R99 – Symptoms and abnormal findings that don’t yet have a definitive diagnosis but require evaluation and management.

MBW RCM’s Expertise in Family Practice Billing

• Certified Coders (CPC): Our team includes certified professional coders with extensive experience in Family Practice billing, ensuring accurate code assignment and compliance with the latest regulations.

• Accurate Modifier Application: We ensure the correct usage of modifiers like -25 and -59 to prevent denials and capture all billable services appropriately.

• Advanced EHR Integration: Seamlessly integrate with top EHR systems including Athenahealth, NextGen, Kareo, and AdvancedMD to streamline workflow and data accuracy.

• Eligibility Verification & Prior Authorization: Dedicated teams verify patient insurance eligibility and obtain necessary authorizations before services are rendered to avoid delays.

• Regulatory Compliance: Full adherence to HIPAA, CMS guidelines, and payer-specific policies ensures secure and compliant billing practices tailored for primary care settings.

Best Practices in Family Practice Billing

Implementing best practices in Family Practice billing is essential for optimizing reimbursement and maintaining compliance. Due to the diverse range of services and patient demographics, practices must establish structured billing protocols and coding accuracy to reduce claim denials and delays. Below are key strategies every Family Practice should adopt:

• Accurate E/M Level Documentation: Clearly document the medical necessity and time spent on Evaluation and Management services to support appropriate E/M code selection.

• Differentiation Between Preventive and Problem-Oriented Visits: Ensure separate documentation for wellness visits and problem-focused services when both are performed during the same encounter.

• Use of Modifier -25 for Combined Services: When a procedure and an E/M service are provided during the same visit, correctly apply modifier -25 to the E/M code to avoid claim denials.

• Proper Annual Wellness Visit Coding: Accurately apply G0438 and G0439 for initial and subsequent Medicare wellness visits, ensuring compliance with CMS guidelines.

• Billing for Chronic and Transitional Care Management: Use codes like 99490 and 99495/99496 to capture non-face-to-face care coordination, ensuring supporting documentation meets time and service requirements.