Andrea Bowers
Guest
I need clarification regarding the Medicare information adding an additional E/M service. I have physicians that are adding an E/M for f/u on the patient's chronic conditions or doing a "med check" at this visit.
Medicare states "An additional E/M service may also be billed if a significant, separately, identifiable medically necessary problem is addressed. The service must be medically necessary to treat the beneficiary's illness or injury, or to improve the functioning of a malformed body member. None of the information and work done to perform the IPPE or AWV may be counted towards the E/M service. Therefore, it would be unlikely that the higher level CPT codes would be billed."
My question is "illness" in that statement above meaning "acute illness" as in sickness, complaint, or ailment? What is Medicare's meaning of "illness". My providers are saying that "illness" can be chronic conditions. So they are combining the Medicare wellness visit along with the follow-up on the patient's chronic conditions so they need not come back a second time. I see a higher level E/M on those more complex patients.
I really need help with this situation so I can be guiding them with what can and can not be performed at a wellness visit.
Thanks
Andrea Bowers, CPC, CPMA
Family Medicine
Frederick, MD
Medicare states "An additional E/M service may also be billed if a significant, separately, identifiable medically necessary problem is addressed. The service must be medically necessary to treat the beneficiary's illness or injury, or to improve the functioning of a malformed body member. None of the information and work done to perform the IPPE or AWV may be counted towards the E/M service. Therefore, it would be unlikely that the higher level CPT codes would be billed."
My question is "illness" in that statement above meaning "acute illness" as in sickness, complaint, or ailment? What is Medicare's meaning of "illness". My providers are saying that "illness" can be chronic conditions. So they are combining the Medicare wellness visit along with the follow-up on the patient's chronic conditions so they need not come back a second time. I see a higher level E/M on those more complex patients.
I really need help with this situation so I can be guiding them with what can and can not be performed at a wellness visit.
Thanks
Andrea Bowers, CPC, CPMA
Family Medicine
Frederick, MD