Hello,
I’m reaching out for some assistance. I have a provider who is strongly insisting that they can bill a 99202–99215 in addition to an AWV even when there is no acute issue and the patient’s chronic conditions are stable.
I have shared the CMS and Noridian guidelines with the provider, but I’m concerned that I may not be explaining the distinction clearly enough. I’ve tried to emphasize that an E/M (99202–99215) can be billed with an AWV only when the problem‑focused visit is significant and separately identifiable. Stable chronic conditions with no changes in management do not meet the criteria for a separate problem visit.
Could someone please advise on another way to explain this to the provider, or share a reliable source that I can send the provider for better clarification? Your guidance would be greatly appreciated.
I’m reaching out for some assistance. I have a provider who is strongly insisting that they can bill a 99202–99215 in addition to an AWV even when there is no acute issue and the patient’s chronic conditions are stable.
I have shared the CMS and Noridian guidelines with the provider, but I’m concerned that I may not be explaining the distinction clearly enough. I’ve tried to emphasize that an E/M (99202–99215) can be billed with an AWV only when the problem‑focused visit is significant and separately identifiable. Stable chronic conditions with no changes in management do not meet the criteria for a separate problem visit.
Could someone please advise on another way to explain this to the provider, or share a reliable source that I can send the provider for better clarification? Your guidance would be greatly appreciated.