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Wiki Physical with additional E/M

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nc_coder

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I know that per CPT guidelines I am allowed to bill an additional E/M code with a routine physical if the visit goes above and beyond the normal routine care. However, the question is what is above and beyond a normal physical. I have a physician that will want to charge an E/M with the dx 401.9. This patient has been treated for a while for this problem. The same rx is renewed. No new treatment is done for this condition. What is the "additional work" that is required to validate the E/M? If someone could direct me to something in writing to present my case to my office, I would appreciate it.
 
An answer....

You would have to have all of the components (the H.E.M.) to be able to use another E/M for the office visit. If there is no additional workup on the patient for the problem then you should not use another E/M code. Just remember if you do indeed use an office code....sequence it first with a -25 modifier then the preventative maintenance code secondary.
 
Does anyone know where I can get this information in "official" writing? I am positive this is being overused in our office, but I need something in writing to present to the office manager and physicians.
 
follow the rules of an office visit, you need a chief complaint, reason for the encounter. A carry over from a same day preventive will not work as that is already part of the preventive. So what is the complaint? what is new being addressed? Since you are charge for 2 office encounters in the same day essentially, then what do you have that will cover a new and different ov that has not already been addressed.
 
Scheduling

Can always note that there are specific patient face-to-face time expectations for each office code. A quick look at the sum total of coded services and actual time scheduled for a patient or patients may result in a discrepancy?

I remind our providers that a possible audit could include a copy of a days schedule.

Just a thought
 
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