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.