Wiki How would you Audit this?

[Ivonne C.]

I am needing help with medicare preventative services. I understand that Medicare covers a "welcome to medicare" physical. and they are also covering a physical every 2 years (w/high risk being covered yearly??), and now with the healthcare reform as of Jan. 2011 they will cover them yearly. Until then lets say a pt comes into the office for an "Annual" visit when medicare is not going to cover the visit, how would you code that? here is an example visit:
HT: 5'0''
WT: 119
BP: 160/92
Allergy: NKDA
CC: Annual
HPI: 69 yo P2 PM no bleeding, no D/C

History:
Last Mammo: 2/2010
Last Exam: 2/3/09
Last Colonoscopy: 2008
Last bone density: 11/18/08

Exam:

HEENT: NL
NECK: NL
Breast: Sym
ABD: Soft, NT
EXT:
Atrophic
VAG:
UT: AV, NT
CX,AD: no masses
Rectal: no masses

Hematest (-)
Labs:
UA: (-)

Assess and Plan:
SBE/ year
BMD
Fosamax 70mg
Gen Cx

Codes billed:
99215
81002
G0328-GW
88142

ICD:
627.3
733.9
610.1
627.2

 

[anseanair]

preventive medicine service

an "annual" physical is an "annual" physical and is coded dependent on the age of the pt., etc. If a provider codes it as an office visit, it's fraud. Some providers, in the past, have done that so the pt. has no charges. I don't see any reason to give a Medicare pt. an annual physical. Typically, they have so many problems that they're being seen on a regular basis anyway. An "annual" visit is a waste of time and money.

 

[Ivonne C.]

Thank you, I was wondering the same thing about the E/M visit. the pt signed an ABN so the pt was fully aware that the "physical" might not be covered. with the CC stating Annual and no other HPI I will relay my findings.

Ivonne