• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Preventive visit with no PEX?

Create Wiki
C

ca_cpc

Networker
Messages
45
Best answers
0
We have a patient contesting her copay because she came in for a PEX and we did not bill it as preventive. The provider did not do a full physical, just the following:
"General:
well developed, well nourished, in no acute distress.
Heart:
non-displaced PMI, chest non-tender; regular rate and rhythm, S1, S2 without murmurs, rubs, or gallops"

I have verified with the provider that she did not do a more extensive exam. There is no ROS, but some gyn history is documented, as well as our usual "Well care template" with auto-populated last dates of service for various tests, etc.
She also ordered labs for the patient's hypothyroidism, which is what we wound up billing for. (A 99212 - barely).
The patient is insisting that since she was scheduled for a PEX, that is what we need to bill it as. I do not see any way this can be billed as a preventive visit, but does anyone else see a way around this? I want to make sure I have all my ducks in a row, especially since the patient in question is also a medical provider and I want to make sure I can answer all her questions clearly.
Thanks!
 
christieanna said:
We have a patient contesting her copay because she came in for a PEX and we did not bill it as preventive. The provider did not do a full physical, just the following:
"General:
well developed, well nourished, in no acute distress.
Heart:
non-displaced PMI, chest non-tender; regular rate and rhythm, S1, S2 without murmurs, rubs, or gallops"

I have verified with the provider that she did not do a more extensive exam. There is no ROS, but some gyn history is documented, as well as our usual "Well care template" with auto-populated last dates of service for various tests, etc.
She also ordered labs for the patient's hypothyroidism, which is what we wound up billing for. (A 99212 - barely).
The patient is insisting that since she was scheduled for a PEX, that is what we need to bill it as. I do not see any way this can be billed as a preventive visit, but does anyone else see a way around this? I want to make sure I have all my ducks in a row, especially since the patient in question is also a medical provider and I want to make sure I can answer all her questions clearly.
Thanks!
Click to expand...
Does the chief complaint show that the patient presented for a well visit with no complaints? if so then shame of the provider for not providing what was requested. If the patient expressed symptoms and that is what the provider addressed then it is not a preventive and the provider is correct. Just because labs for hypothyroid were ordered does not make it a visit for hypothyroidism. There must be more to this story.
 
You must log in or register to reply here.
Top