Wiki Any reimbursement issues w/AWV & problem-oriented visit?

[Rita Bartholomew]

I advised our Internal Med specialists that they can perform and bill for an AWV and a problem-oriented visit at one of their patient's regular f/u visits for their chronic problems. They're hesitant to do this because of the fear of raising flags and being considered an outlier, and sparking an audit. My guess is that this would be a relatively common practice in an internal medicine practice. But I don't know if there have been increased audits on a national basis for providers billing problem-oriented E/M's with an AWV. Does anyone have any info about this?

 

[OCD_coder]

They are certainly, rightfully concerned. So here is my opinion only, if the patient comes to the office and the intent of the visit is to perform an AWV or IPPE and that said patient as no complaints other than maybe a refills on chronic medications, that alone is not sufficient to justify a separate E&M service at the same time. That is incidental.

But if the patient is having problems and the provider must perform workup to determine what the treatment plan is going to be, eg. adjustment in medication or a change in medication then bill an E&M and perform two distinctly separate services with a modifier 25 on the E&M not the AWV. One tip I give the providers is that each CPT needs a separate document/report to support each code. Since the AWV have specific criteria that have to be addressed this should be kind of easy.

Our physicians have decided they will not be performing both at a single service, if the patient has complaints they will address the problems and report and E&M and reschedule the AWV. I would defer to the physicians preference first, not my need to gain revenue.

 

[mitchellde]

I agree. However keep in mind that as of Oct 1 with ICD-10 CM the general exam codes will not allow a symptom code to be used as an additional code. This is an exclude 1 exclusion.