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Physical vs New PT visit

ssjogren

New
NAB Member
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6
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My husband went to the Dr. and I have questions regarding the coding because I am so close to this I wanted the opinion of others before I question the office.

Pt called up and requested physical examination due to being new in the area and needed to establish a PCP. Pt received bloodwork and full ROS Hx and Exam. During exam Dr. noted Post nasal drip and deviated septum. (Both present since birth and never treated by this or any other Dr.) When labwork came back pt had elevated cholesterol near but not over normal limits.

This was coded as a new pt visit 99204 with hypercholesterolemia, deviated septum and allergies.

No medications were prescribed or follow-ups scheduled.

The next year same thing pt requested physical again and only they coded as 99214 with same Dx's.

I inquired to the office as to why he is not being charged a physical because he requested one and was told that they do not schedule new patients for physicals their first visit and this was just a get to know you visit and if it was a physical an EKG would have been done?? The second year they said was a follow-up to the first and that they only do physicals every few years at the doctors request?

I would appreciate any input as I code for several PCP's offices and do not feel this is correct but feel my personal relationship may taint my opinion.

Thanks so much!!
 

Lisa Bledsoe

True Blue
Messages
2,045
Location
Greeley, Colorado
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First visit - how can they get a medically necessary 99204 for a deviated septum and post nasal drip? And how do they code 272.0 after the visit ("when the lab work came back") since it was not known at the time of the visit? If the patient asked for a physical and that is what was done, they cannot code a new patient visit. It must be coded for what was done. And, if they don't do "physicals" at the first visit how can they "get to know you"? Uusually a meet and greet/get to know you is for the patient to get to know the physician to decide if they want them as a provider or not, not the other way around. If he had scheduled for the post nasal drip and deviated septum this would be different...

Second visit - again, if a physical was requested and performed they can't code for a problem-oriented visit (unless they code for both preventive and e/m but if all is stable it would not meet the requirements for the problem-oriented e/m).

I find this unethical, but that's just me...
 

RebeccaWoodward*

True Blue
Messages
3,126
Location
North Carolina
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0
I agree

If a PE was requested, this should have been the service performed. It may be the practices policy to conduct/perform a "meet and greet" or "get to know you visit" for the initial service but the carrier is not required to pay for this; nor should the patient. I agree with Lisa, this certainly sets off some alarms for me. I would contact your carrier and tell them exactly what happened. I'm certain this will prompt a chart review.
 
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