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KoBee

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If a provider sees the patient for a procedure that was prescheduled and is trying to also bill a separately E/M with just " for further follow up " on same day , my understanding that if patient is scheduled for a prescheduled procedure, then the provider cannot bill a separate E/M especially if there is no complaints or concerns from the patient.


Please advice :)
 
You are correct. There is an element of EM built into the procedures. If the intent of the appt was for the procedure and there wasn't a separate significant problem being addressed, he can only bill for the procedure.
 
Hi
Yes this is correct that if the patient does not have a problem....cannot create a new record. However I have worked at medical office where a patient is being treated for 2 separate clinical issues; ongoing illness and a worker comp injury. One record is created for the WC injury but another record is created for this established patient about an ongoing health problem. The physician had to document 2 record same day since each being treated for differ reasons and the documents went to differ sources such as Work Comp and the patient's private insurance for the ongoing chronic illness. I just wanted to share this thought. I hope I helped you too.
Lady T:)
 
My advice is not to try to do two separate "visits" on the same day. Whether one visit is a procedure and one visit is a visit, or whether they are both visits.

Work comp claim and medical problems? The patient comes in on two different days. That way you would survive any audit that said you were double billing health insurance and work comp for the same session.
Procedure and a medical problem? Two different days.
Monthly medication management visit and another problem? Two different days.

Two or three similar medical problems? All on one day.
 
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