I am looking for education material to present to the providers on the topic of billing an annual Medicare visit with a problem visit on the same date of service. I informed the provider the problem visit has to be separate identifiable medically necessary E/M service to treat the beneficiary's illness or injury, or to improve the functioning of a malformed body member. The problem I am having is explaining myself when treating Hypertension, hyperlipidemia, (chronic conditions) at the time of the annual visit. Can you please help me gather some information. I have been on CMS website and viewed all information but the only explanation it gives is the statement about medical necessary. Thank you so much in advance
Sheila Sweetland, CPC[/QUOT
CMS has information regarding the billing of a separately identifiable E/M on the same day as an AWV. They have a quick reference guide w/ FAQ's
Here is what it states:
Q: Can I bill a separate Evaluation adn Management service at the same visit as the AWV:
A: Medicare may pay for a significant, seprately identifiable, medically necessary E/M service ( 99201-99215) billed at the same visit as the AWV when billed with modifier -25. That portion of the visit must be medically necessary to treat the beneficiary's illness or injury, or to improve the functioning of a malformed body member.
I have always trained my providers to make sure they document a separate note, also if these conditions are stable it throws up a red flag to me to bill for an e/m at the same time as the AWV ( just my opinion).
I tend to think back on the subject of a preventive visit and a problem/acute e/m visit on the same day that states: "If any abormaility is encountered or a preexisting probelm is addressed in teh process of performing a preventive medicine evaluation and management service, and if the probelm or abnormality is significant enough to require additional work to perform the key componenets of a problem oriented e/m service, then the appropriate office/outpatient code 99201-99215 should also be reported" ( again this is the logic I use, you do not have to use it but I like to have a rule of thumb for these issues that helps me decipher the information and the necessity).