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Annual exam vs Physical exam question

NIEVESM

Networker
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Hello,
I hope somebody can reply today on this one, If physician documented patients is here for her annual exam, for me this sound to be a physical base on the documentation. Does anybody agree? :confused:
 

NIEVESM

Networker
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Mitchell, thanks for your quick response, but I am still confuse I am recently coding for a physician that use the term "annual exam" on the HPI, but never documented V70.0 on the assessed problems. I contacted the previous person who coded for him how she resolve this matter and she replied: "I only had to look at the entire note to see if was truly a physical or annual check up base on the pt chronic conditionsassessed mmm, I was taught a Coder should never to assume! When I question the Dr. on these matter he seems to be very confuse. I explain that if he documented on his HPI, patient is here for an annual exam or check up, It may me think this is a physical do you feel he is documented correctly?
 

Lisa Bledsoe

True Blue
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2,045
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Greeley, Colorado
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I suggest educating your physician that what is documented in the assessment and plan is indicitave of what the encounter was for (kind of trumps the chief complaint/HPI). It should not take much for him to state as the first dx that the patient was seen for annual health exam.
 

mitchellde

True Blue
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13,293
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Columbia, MO
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IMO an annual check up and an annual physical are one in the same. The physician does not have to list the actual dx code for us to be able to use it. He states annual check up with no complaints then it is a V70.0. Some physicians do not want to use this dx with a preventive E&M because "Medicare does not pay for this". An annual wellness check up/physicial is a preventive visit no matter how you phrase it and should be coded with a preventive E&M and a V70.0. I have heard after Jan 1 Medicare will be paying for 1 annual exam each year. I think a ton of providers will suddenly be billing for preventive!
 

NIEVESM

Networker
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I agree with you Debra on that one... I believe also the only reason he never assessed
v70.0 is because he know MCR is not paying. But like I mentioned to him I coded by documentation, so if he want to bill an annual exam with other diagnosis but the v70.0 he will have to be more specific on his documentation. I have not hear about Medicare paying annually for physical if you can find more info and share will be very appreciate. Thanks again for your help and support.
 

NIEVESM

Networker
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Debra you mentioned that some physician do not want to use the V70.0 with a preventive because THEY know MCR will not pay...I read somewhere here that when a physician is trying to get paid from Medicare for a service that is not covered that could be fraud...If the intent of the visit was for a preventive visit then that is what should be billed. Just because the patient has other issues does not mean the preventive service was not done.
 

mitchellde

True Blue
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Columbia, MO
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And you would be correct in that! Several people have indicated they have heard from their regional carrier that Medicare will pay for prevent in 2011. I read this about a month ago but I honestly do not recall where it was.
 

NIEVESM

Networker
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81
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Thanks again for your help! If this is a fact many physicians are going to be very happy lol!!
 

mitchellde

True Blue
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Location
Columbia, MO
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One other thought along this line..... If you were Medicare how would you target audits for this type of "fraud" ?? Start covering preventive and see how many providers sudenly change their practice from billing high level ov to billing preventive with V70.x. That is one sure way to target those that were billing incorrectly. That is my take on this.
 

Stefanie

Networker
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My providers are definitely excited about the preventive services and Medicare, but I have cautioned them that this doesn't necessary mean Medicare won't implement a whole list of must have criteria to be reviewed and documented for the preventive service to be considered a covered benefit by Medicare. It would be way too easy to just pay for a preventive... :)
 
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