carolynn
New
New to the field, patient seen for annual exam with pre-existing condition listed on HPI, no comprehensive exam or history on pre-existing condition. Just to continue meds. Can we bill for an E/M? Thank you.
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Wiki preventive with E/M
- Thread starter carolynn
- Start date
mitchellde
True Blue
The short answer is no. The long answer is... It is an expectation that the provider will cover all chronic conditions and order labs and reorder medications. You must have documentation of an abnormality or an exacerbation of a chronic condition to be able to attempt to bill an E&M with a preventive E&M. Also you must have independent of the documentation for the annual the elements of an office visit level without duplicating any of the elements of the annual.
kroemer4
Networker
Preventive with E/M CPT Plus! Excerpt
I have saved an excerpt from a CPT Plus! 2013 eBook that explains it well for my practitioners:
"If an abnormality is encountered or a pre-existing problem is addressed ... and if the problem or abnormality is significant enough to require addition work" in support of problem-oriented E/M service, then it would be appropriate to bill the preventive medicine service, additional E/M and the -25 modifier. Otherwise, "[a]n insignificant or trivial problem/abnormality that is encountered in the process ... [and] does not require additional work" of an E/M does not support a significant, separately identifiable E/M visit on the same date of service.
I have saved an excerpt from a CPT Plus! 2013 eBook that explains it well for my practitioners:
"If an abnormality is encountered or a pre-existing problem is addressed ... and if the problem or abnormality is significant enough to require addition work" in support of problem-oriented E/M service, then it would be appropriate to bill the preventive medicine service, additional E/M and the -25 modifier. Otherwise, "[a]n insignificant or trivial problem/abnormality that is encountered in the process ... [and] does not require additional work" of an E/M does not support a significant, separately identifiable E/M visit on the same date of service.
Quaker
Networker
What if the patient was scheduled for their 6 month chronic condition visit (eg, hypothyroidism, IDDM, COPD) and an AWV on the same day? Provider has 2 separate notes supporting each service, AWV and E/M. After specific in depth review and assessment of the chronic conditions, Rx medications were refilled since the provider deemed each condition stable. Can an E/M be reported in this case OR is this considered included in the AWV?