AWV and problem visit

kbrasher12@icloud.com

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I know a million things have been posted regarding this issue. If a patient comes in for a wellness and the doctor renews meds for chronic conditions, can you bill a seperate E/M code? I realize if they do any additional workup or add new meds because a chronic condition as exacerbated or a new condition arises, you could bill for the problem visit along with the wellness. I'm just confused as to the renewal of medications.

Thank you!
 

Quaker

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Good question! I'm struggling to answer the same question. Who is your MAC?
 
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Check with the patients payer policy. However, in some cases you will have a patient come in and discuss a current "new" problem. Say for instance patient complains they are having uti symptoms. The wellness would be 1. 99xxx---(wellness) 2. 992xx-25 (modifier on the 2nd E/M service) and what ever other services such as u/a, lab work etc.. dx would not be z00.00, rather it would be with abnormal findings, following the appropriate dx codes and pointers.

However, I think if the patient comes in for his wellness with no additional problems, not complaining of anything, and is just getting a refill on the prescriptions he already takes I would probably not code an additional e/m service with that. I hope that helps...
 
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preventive and renewing rx

I know a million things have been posted regarding this issue. If a patient comes in for a wellness and the doctor renews meds for chronic conditions, can you bill a seperate E/M code? I realize if they do any additional workup or add new meds because a chronic condition as exacerbated or a new condition arises, you could bill for the problem visit along with the wellness. I'm just confused as to the renewal of medications.

Thank you!
In order for there to be a significant and separately identifiable E/M, there must be documentation of key components and/or time spent counseling and/or coordination of care. Renewal of medications without documented evaluation and management is not reported.

On the other hand (as you note), if there is documentation that a chronic condition is not improving and a new or increased dosage of medication is prescribed, that is a valid E/M service. If there is no new or refilled prescription but the conditions are evaluated as evidenced by the documented history, examination, and assessment and plan (e.g., conditions are stable or improved), then you have a significant E/M service and, if you can separately identify it (mark out the stuff related to the preventive service and see what's left) then it is reported with modifier 25. Be careful not to discount the work your physicians do just because the patient may have requested a preventive service (no out-of-pocket costs) when they are due for re-evaluation of chronic conditions.

Hoping that is helpful.
Cindy
 
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