Wiki Preventive + E/M


Iron Station, NC
Best answers
I am fairly new to family practice coding. I know I can bill prev visits and E/M if there is documentation of services above and beyond the routine prev services. My question is what elements define a prev visit and how do I know when the services have gone beyond the customary routine care? If an encounter form is given with the prev service and E/M with the routine diagnosis and (for example) hypertension and hyperlipidemia, what entitles the provider to bill a separate E/M with these diagnostic codes? Would the evaluation of these diagnoses not be part of preventive care? I understand the boundaries with let's say prev and allergic rhinitis. When patients call questioning this billing, I still have a hard time explaining how the service was above and beyond the routine service. The usual statement is "Well, am I not allowed to discuss any conditions I may have with the physician? I though that was what the annual routine visit was for." I need a cut-and-dry explanation I can give of what defines preventive and what defines the additional diagnostic service.
It basically all depends on how good your doctor's documentation is and if you can actually pull out elements for an office visit along with a preventative visit. An example of this would be if the patient comes in for a preventative exam but also is treated for a cold with meds. You would bill the preventative visit plus a 99212-25 for the E/M