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!
"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!