Wiki Sick and Wellness Same Day

[kkingklkng]

Can someone please let me know your opinion on the following scenario using the new 2021 guidelines if a separate E/M should be billed.

A teenager comes in for there annual physical. Subjective: History of menometrorrhagia, which has improved since being on birth control pill. They are interested in increasing the dose of the fluoxetine that she is on, sometimes has breakthrough troubles yet. Sibling is on a higher dose and they thought perhaps they should be also. Still does have some trouble with SOB with exertion. Last chest x-ray was normal. I had a long discussion with mom because her murmur is still quite loud, 3/6. It is lounder than it was the last time a year ago. Pectus excavatum today seems to be a depth of 3 cm, where it had been about 2 cm the last time a couple of years ago. It is different this year, however, there is breast tissue. The rest of the view of systems is unremarkable.

OBJECTIVE:
Height
Weight
Vital Signs
Heart: Unremarkable except for 3/6 murmur

ASSESSMENT AND PLAN:

1. Annual physical. I would like her to have an echocardiogram and see Pedictric Cardiology for followup.
2. Menometrorrhagia. A CBC, ferritin, and basic metabolic panel will be ordered. They have been anemic in the past. Refill Previfem for a year.
3. Major depressive disorder. Increase fluoxetine to 40mg. Talk in a month to see how they are doing and follow up on cardiology workup.

 

[suki_26]

From my understanding a separate E/M code can only be used if there is a new complaint. Unless I missread it everything discussed here is related to previous visits. If the patient came in discussed all of this and then also wanted to discuss a rash on her leg... now that is a different issue and would qualify for the additional OV E/M. New findings on previously addressed issues doesn't qualify

 

[lindseykelly3191]

New/Acute problem or concern with additional work-up required, you are able to bill a separate E&M Code. There has to be additional work-up for it to qualify as a separately identifiable procedure. This means an X-RAY or LAB has to be done, not just treatment.

 

[vinessachilders]

Can someone please let me know your opinion on the following scenario using the new 2021 guidelines if a separate E/M should be billed.

A teenager comes in for there annual physical. Subjective: History of menometrorrhagia, which has improved since being on birth control pill. They are interested in increasing the dose of the fluoxetine that she is on, sometimes has breakthrough troubles yet. Sibling is on a higher dose and they thought perhaps they should be also. Still does have some trouble with SOB with exertion. Last chest x-ray was normal. I had a long discussion with mom because her murmur is still quite loud, 3/6. It is lounder than it was the last time a year ago. Pectus excavatum today seems to be a depth of 3 cm, where it had been about 2 cm the last time a couple of years ago. It is different this year, however, there is breast tissue. The rest of the view of systems is unremarkable.

OBJECTIVE:
Height
Weight
Vital Signs
Heart: Unremarkable except for 3/6 murmur

ASSESSMENT AND PLAN:

1. Annual physical. I would like her to have an echocardiogram and see Pedictric Cardiology for followup.
2. Menometrorrhagia. A CBC, ferritin, and basic metabolic panel will be ordered. They have been anemic in the past. Refill Previfem for a year.
3. Major depressive disorder. Increase fluoxetine to 40mg. Talk in a month to see how they are doing and follow up on cardiology workup.

Because you are running labs and changing medication, this would qualify for a separate E&M. Wellness/preventive means an overview of the patient's health and any changes since last wellness. When you run labs, you are performing evaluation of a new condition and/or management of an existing condition, which is what E&M stands for. Add a modifier 25 to your E&M, and it should be paid separately from your wellness/preventive.

 

[bgrasson]

Personally I would address the sick visit and have them come back for their wellness. Most carve out visits will not get paid anyways.