kristy2
Contributor
We bill for an internal medicine group. The office manager there has been reviewing the office notes on all routine physicals and if the doc reviews any other symptoms, ie HTN, Wgt gain, Diabetes...and so on..., she sends the fee slips back and advises them to add a separate E&M (99212-99214) with modifier 25. After seeing numerous physicals come through this way, we asked to see the office notes so we can review before sending to insurance. After reading all the notes, we have come to the conclusion that we totally disagree with the office manager. In almost all cases, the patients clearly presented for a physical. Some discuss an underlying problem or concern, but almost all have no follow up or diagnostic testing done. I have been studying for the CPC, and just took my exam last week. But, it is my understanding that a separate E&M can (and should) only be billed if there is a completely separate work-up done at the time of service with a course of action for treatment to follow. The office manager strongly disagrees with me. Does anyone know of a good source of documentation to help me, or her, understand this better?! I don't want the docs to be misinformed by either one of us!