Wiki Preventive service and separate E/M

Create Wiki
E

epoynter

Guest
Messages
2
Location
Chesapeake, VA
Best answers
0
Would like opinion on the following. I billed preventive visit along with 99213,25 for HTN. Provider states;

HTN/HLD/DM etc are chronic conditions that are also evaluated during physicals with cardiovascular risk prevention.

HPI states : chronic comorbidities stable, noted elevated BP. reports a little better @ home, mostly 130-140s

The A/P documented:
Assessment / Plan
1. Adult health examination-
-routine labs reviewed
-preventative screenings as below
-vaccinations as below. had covid booster and flu shot 10/2023 @ employer
Z00.00: Encounter for general adult medical examination without abnormal findings
2. Screening for malignant neoplasm of breast-
-BIRADS 2 5/2024, +dense breast tissue
-h/o breast cancer, is not following with breast clinic or oncology
Z12.39: Encounter for other screening for malignant neoplasm of breast
3. Screening for malignant neoplasm of cervix-
-negative 11/2022, repeat 5yrs (2027)
Z12.4: Encounter for screening for malignant neoplasm of cervix
4. Screening for malignant neoplasm of colon-
-no FH of CRC, brother had several polyps, colonoscopy 5/2022 with adenomatous polyps x2, repeat 5yrs (2027)
Z12.11: Encounter for screening for malignant neoplasm of colon
5. Osteopenia-
-last DEXA 5/2024
-Vit D/Ca supplementation, daily sunshine, walking/strength training
M85.80: Other specified disorders of bone density and structure, unspecified site
6. Type 2 diabetes mellitus without complication-
-good @ 6.4%, continue with regimen and lifestyle changes
-reports annual DM eye exam wnl. no significant DM neuropathy sxs, has RLS @ baseline
E11.9: Type 2 diabetes mellitus without complications
  • HEMOGLOBIN A1C, FINGERSTICK
  • MICROALBUMIN, URINE
7. Essential hypertension-
-repeat better but still >140/90, add to regimen with lifestyle changes
-send BP readings in a few weeks for review
I10: Essential (primary) hypertension
  • losartan 25 mg tablet -
    • Take 1 tablet(s) every day by oral route as directed for 90 days, for blood pressure. Qty: (90) tablet Refills: 3 Pharmacy: CARELONRX PHARMACY, INC.

Was I incorrect in coding 99213,25 for the HTN (chronic condition unstable) which provider prescribed an additional medication?

Thank you in advance.
 
I think that is fine, but the "Z00.00: Encounter for general adult medical examination without abnormal findings" doesn't appear to be the correct Dx as there was an abnormal finding.
Happy to read other opinions.
 
Thank you so much for your response. I do code z00.01 however some insurances will actually deny for that code. I do appreciate the backup on the billing of 99213,25.
 
I have a follow up question: If a patient comes in for preventive exam and has chronic conditions (regardless of how many) and all are stable, and medications are refilled but not changed the additional E/M code would not be billed. Correct?
 
Hello, I am not an expert. By reading everything posted to OBGYN forum, I made a conclusion, that anything, unrelated to preventative visit can be billable as e/m -25. If MD assessed, monitored, reviewed etc those chronic Dx and/or prescribed Rx/refill= I would code for E/M as a separately identifiable extra service performed. Because it's not a part of Preventative visit. If md just refill Rx ( one sentence), I would not code e/m as insufficient, not extra/above and beyond service.
 
From AAPC Article "Recommended Ways to Document and Report a Preventive Visit":

What Services Must Include
Checking the status of chronic conditions and refilling on going prescriptions is expected during
an annual preventive exam and do not warrant the billing of a separate problem-oriented E/M
service. If a chronic condition is not being well controlled, however, and decisions are being made
as to how to treat the patient to improve control (changing the dosage of medications, changing to
a new medication, etc.), this may substantiate a separate problem-oriented E/M service. For
example, more work is done (and documented) than what is performed normally during an annual
preventive exam.
 
You must log in or register to reply here.
Top