Office Visit vs Routine Exam


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I am trying to find out how to tell the difference between an office visit and routine exam. We have patients that will come back every 6 mos for a dm/chol/htn check and the doctor will bill a routine exam, but the insurance co will always deny (medicare) and then the patient will call stating that they just came in for their 6mo check-up. Here is a brief descp of what the physician dictated......

CC: Diabetes and Cholestrol
Current Problems: DM/HTN/Hyperlipdemia/Kidney Stones/benign prostate hypertrophy/dysphagia
Family History-Done
Past Medical History-Done
Review Of Sytems: Recent sore throat. He took some antibotics which seemed to help. He pointed to the right side of the throat as the site of discomfort. This was going on for about two weeks but now has subsided.
Social History-Done
Physicial Exam- BP 136/81, pulse 77, temp 97.7 and weight was 171. HEENT-negative, The pharynx is mildly injected. No masses or nodes in the neck. Carotids are negative. Thyroid was not enlarged. Three fingerbreath larynoptosis. Chest was clear. Heart was regular. Abdomen was soft. Bowel sounds were present. No masses. No rebound. No tenderness. Extremities-negative.
Impression-1. New onset dysphia, 2. Recent Pharynigitis, 3. DM 2, 4. Hyperlipidemia, 5. Bengin Prostatic hypertropy.
Plan-He will follow up in six months. He will continue metformin. We will get a barium swallow and upper GI. He will start Nexium. Labs were ordered for six months exam.

CPT: 99397
DX: V70.0, 250.00, 787.29

Need help if this was coded right!!! Thanks for any help!!!


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That is a follow up not a routine exam. A routine exam is mostly a yearly exam to make sure everything is okay... This was a follow up for sure. This should be coded 9921x