Billing of well & sick visits same day

strybusk

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A pt comes in for a preventative visit and there is an area for New Problems & the doc has entered "NONE" but bills for a sick visit as well. All we can figure at this monent is he is RENEWING scripts for their chr conditions...not ordering new meds just renewing...does this constitute a sick chg and the E/M being applied is 99214/99213. We can not see any other reason for them doing this. Some input would be appreciated..thx :confused:
 

ploewe

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No!

If there is no documentation to support a SIGNIFICANT additional E&M service (without repeating the comp hx and exam required for a well visit) then only the preventive visit can be billed. What more did this physician do than he/she would have done for the well visit? If it's only writing a prescription, then that would not support a second service. And at our institution, the occasional dual visits require two separate parts to the documented note.
Hope this helps.
 

btadlock1

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I agree. Chronic, stable conditions such as HTN become relevant risk factors for that patient - and those have to be addressed for the well exam; so without any significant change that would require him to consider new things and make a medical decision, you haven't got enough to justify the sick E/M. Rewriting an old Rx doesn't count.
 
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