Family Medicine Medical Billing Services
Family medicine bills a high volume of low value claims, which means small systematic errors compound faster here than anywhere else. A practice consistently coding one level too low loses more over a year than most practices lose to denials.
Codes this specialty bills most
| Code | Description | Watch for |
|---|---|---|
| 99213 | Office visit, established patient, low level medical decision making | The default for many practices, including for visits that supported 99214. |
| 99214 | Office visit, established patient, moderate level medical decision making | Two or more stable chronic conditions being managed generally supports this. |
| 99396 | Periodic preventive medicine examination, established patient, 40 to 64 years | Billable alongside a problem visit with modifier 25 when both are documented. |
| G0439 | Annual wellness visit, subsequent | Medicare. Not the same service as a preventive physical, and the required elements differ. |
The denials this specialty sees
The largest revenue problem in family medicine is not a denial. It is undercoding, and it is invisible because the claim pays. A visit managing three chronic conditions with medication adjustments is moderate complexity and supports 99214. Coded 99213 out of caution, it pays less, every time, and nothing in the system objects.
The 2021 E/M revisions made this easier to get right, because level can now be decided by medical decision making alone or by total time on the day of the encounter. Many practices never adjusted their habits.
Where real denials do occur, the most common is a preventive visit and a problem visit on the same day without modifier 25, or with modifier 25 applied to a note that does not separate the two services. See CO-97.
Diagnosis specificity is the other one. ICD-10 rewards specificity and unspecified codes draw medical necessity denials on the tests ordered alongside them. See CO-11.
Our coding review looks at level selection across the whole panel, which is where a systematic habit shows up.
Payer notes
The 2021 and 2023 E/M documentation guidelines apply across payers, but audit behavior differs. Medicare Advantage plans in particular tend to review level distribution across a practice rather than individual claims.
Annual wellness visits and preventive physicals are different services with different required elements. Billing one while documenting the other is a common and easily corrected error.
Common questions
How do we know if we are undercoding?
Compare your level distribution against your specialty benchmark. A practice where nearly everything is a 99213 is either seeing unusually simple patients or leaving money behind, and reviewing thirty charts will tell you which.
Can we bill a physical and a problem visit on the same day?
Yes, with modifier 25 on the problem visit, when the note documents both as distinct services. The problem-oriented work has to stand on its own, not read as part of the physical.
Should we use time or medical decision making to pick a level?
Whichever the visit actually supports, chosen consistently. Time is simpler to defend when it is recorded contemporaneously. Medical decision making usually captures more value on complex chronic care.
See what your claims are leaving behind
Send us a month of remittance data and we will tell you what it says: which codes are being denied, how much of it is recoverable, and how long your money is sitting in A/R. It takes about a week and there is nothing to sign.