Wiki Preventative not met

[sparkles1077]

Hello Fellow Coding Gurus,

Patient presents for preventative medicine. The provider notes history of hyperlipidemia and orders labs. Also completes a comprehensive history and exam. This does not really satisfy preventative, as the provider does not document any counseling/anticipatory guidance/risk factor reduction interventions. Would you code an E/M? I have heard some may consider this service noncompliant and not bill anything because the patient initially presented for preventative, which was not performed. However, it still seems like they could get an E and M.

Let me know of your thoughts/experience.

Thank you

 

[mitchellde]

if you bill a regular E&M then the patient owes a co-pay and does not get credit from their payer for the annual. It is not the patient's fault the provider did not provide all the elements of the preventive.

 

[sparkles1077]

Thank you for your response Debra. I have heard the concern about the patient copay however, from a documentation perspective the visit does not meet preventive requirements. Upon audit, it would have to be repaid. The only option left would be a no charge, but the physician is having a face to face with the patient so the physician should be able to bill for the encounter. I can not think of any guidelines or policy that give guidance about this issue. Would you do a no charge visit?