Re-evaluating a problem while patient is here for another reason


True Blue
Boca Raton, FL
Best answers
Patient was evaluated and treated for Problem A. He is instructed to return in two months for re-evaluation.

Meanwhile, just three weeks later, he develops unrelated Problem B and comes in. Since he's here anyway, the provider takes a look at Problem A and documents an exam and re-evaluation of it (in addition to the exam and evaluation of Problem B).

Can the re-evaluation of Problem A be counted toward the E/M? I'm thinking not, because "let's just take a look at it as long as you're here" does not, in my mind, constitute medical necessity (and we all know that "medical necessity is the “overarching criterion for payment").

What do you think?
Last edited:


True Blue
Best answers
It's hard to give a good answer on this without seeing the provider's entire note and without knowing the nature of the problems. As a general rule though, I would not penalize provider for something like this. It's really up to the clinician to make the determination as to whether or not it was medically necessary and appropriate to address that problem during the visit and there may be a valid argument to support it.