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Does the assessment count as the reason for the visit?

J

jackieconvery12

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7
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Washington Twp, MI
We are billing for botox injections. The physician documents the pt is here for botox. Then details the procedure being done, then towards the bottom he documents assessment: chronic migraine.

Would the assessment count as the reason for the visit?
 
If the patient is only there for the botox injection, there has to be something over and above for the provider to bill for an e/m. Otherwise, you can only bill for the injection.

That presenting problem has been an issue with providers not understanding that "here for treatment" is not a valid presenting problem. Documented assessed problems warranting the treatment would be the diagnosis for the injection.
 
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