Need definition of "Additional Work" re: Preventive Medicine Service.

Lisa Schwaesdall

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What actually constitutes "additional work" when billing for a seperate E/M-25 in addition to a Preventive Medicine Service? Need examples. CPT Book states IF abnormality or pre-existing problem is addressed & is significant enough to require add'l work....
 

ndhight

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Say pt comes in for a vaccination or physical but also wants doc to look at a mole. The mole would be additional because it doesn't belong with the vaccination appt or a routine physical. Unless of course it is a dermatologist.
 

Jagadish

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The following is from WPS Medicare....

3) How is a "significant issue" determined when performing a Preventive Medicine Service (Routine Annual Check-up) that would then warrant a split billing of a covered Evaluation and Management (E/M) and the Preventive service, in the office setting for an established patient?

It would be considered a "significant issue" when a new or different abnormality/medical problem or a change or exacerbation of a pre-existing condition is revealed in the process of examining the patient and the physician determines it is significant enough to require additional work to perform the key components of the appropriate level office E/M.

hope this helps!
 
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