Wiki Preventative Visit and E/M

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baroquecoder

baroquecoder

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Listed in the chief complaint is "cough and wellness check"

there is an HPI for the cough and an Exam and ROS.


There is a brief "wellness HPI" and mention of vaccines and nutritional guidance

my question is does this qualify as a 99392 and 99214 if the patient is presenting with a problem at the outset? My understanding is that if the patient has a new problem they are presenting with, then this no longer is a 'well' visit. I do understand that if in the course of a 'well' visit an abnormality is discovered and if that abnormality is significant to require all the components of an E/M, then it should be additionally reported. This problem was not discovered during the course of a wellness visit, but presented at the outset.

Thank you!
 
I don't believe you can qualify for both. Since the patient presented with the cough you can bill either a sick visit and defer the wellness to another appointment or what most of my providers do is bill the wellness with no abnormal findings. They address the cough but the there is no additional charge. And a 99214 is an intense level to be billing for a cough so I would not do that at all.
 
Preventative and E/M

mitchellde said:
I don't believe you can qualify for both. Since the patient presented with the cough you can bill either a sick visit and defer the wellness to another appointment or what most of my providers do is bill the wellness with no abnormal findings. They address the cough but the there is no additional charge. And a 99214 is an intense level to be billing for a cough so I would not do that at all.
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Hello!
Thank you for answering my post. I noticed you had answered a similar question on an older post. I was wondering if you have found any documented guidance regarding ordering a preventative and e/m when patient presents at the outset with a problem? Seems to me this would go against the placement of the mod. 25, because the problem oriented service then was 'reasonably anticipated' from the get go. I agree with your assessment. If you have any further information that you have gathered to back up this assessment, I would so appreciate it.
 
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