Reader Questions:
Medicare Wont Pay for Routine Follow-Up
Published on Tue Jul 01, 2003
Question: How should I code if a patient continues to follow up with a doctor after the initial 90-day global period? If I report an E/M service with the appropriate V code diagnosis (no symptoms are present, and the visit is strictly follow-up), Medicare denies the service as routine.
Michigan Subscriber
Answer: If the visit is strictly for follow-up for a previous surgery, with no new symptoms present (in other words, the physician sees the patient just to make sure everything is OK), the service qualifies as preventive care only. Although you may report the appropriate-level preventive medicine services code (99381-99397) with a V code diagnosis, most payers (including Medicare) do not recognize such visits as medically necessary and therefore will not reimburse for them. As a final resort, you could ask the patient to sign an advance beneficiary notice (ABN) and bill him or her for the service.
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