How to code Routine exam, medical findings

[Orthocoderpgu]

Patient comes in for a routine exam. Patient also has Asthma and high blood pressure. Since the patient was treated for a significant medical condition, this is no longer a "Routine" office visit: right?

 

[dmaec]

Hi quinnwebb,
I haven't read the documentation but just going by what you posted it appears the asthma and high blood pressure are "chronic" conditions, if so - it's still "their" routine physical - I'd still code it as a preventive service. I wouldn't split bill a preventive and an E/M level unless the asthma and high blood pressure are "new" issues now being found and treated. And documentation can support both services. But, just because a person has health issues, doesn't mean it's not a routine physical.
{that's my opinion on the posted matter}

 

[Christine Bekker]

Christine Bekker, CPC, CPC-I

2008 CPT guidelines state; "If an abnormality/ies is encountered or a prexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem/abnormality is significant enough to require additional work to perform the key service, then the appropriate Office/Outpatient code 99201-99215 should also be reported. Modifier 25 should be added to the Office/Outpatient code to indicate that a significant, seperately identifiable Evaluation and Management service was provided by the same physician on the same day as the preventive medicine service."

Chronic has nothing to do with it, what is important is was there a seperate HPI, ROS, possibly a seperate exam for the problem, and scorable MDM, then you have met the guidelines to charge for both.

The guidelines do go on to state that if the problem/anormality does not require aditional work and the performance of the key components (Hx, Exam, and MDM) then the problem-oreinted E/M service should not be reported.

If your payor denys the two codes together you should always appeal the denial with a copy of these guidelines from CPT.

 

[dmaec]

Christine Bekker, I couldn't have quoted better myself
""The guidelines do go on to state that if the problem/anormality does not require aditional work and the performance of the key components (Hx, Exam, and MDM) then the problem-oreinted E/M service should not be reported.""

which was my point exactly -and from what was posted, it doesn't appear she has enough to support two services.
again, my point was - if the patient has chronic conditions that are simply "the same as always",...no, I would not code two visits - if they were newly found conditions - (or let me add here to clarify; chronic conditions causing issues again) then yes, documentation supporting ... I'd code both services.


I'd have to disagree slightly on the chronic not having anything to do with - I feel it does - because, if it's chronic - and nothing has changed, you wouldn't have enough to code a separate E/M with the px - however, if it's chronic and causing issues again, you might - and, if it's "new", not chronic - you most likely would have enough to support both services...
{that's my opinion on the posted matter}

 

[Orthocoderpgu]

Thank you both for your responses. They have been a big help. Thank you !

 

[Hariharan]

AS other posted, its correct to code the routine visits V70.0 rather then coding for the chronic condition and to the reason for visit is Routine...


Thanks
HariHaran