Wellness visit and problem visit

kbrasher12@icloud.com

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If a patient is in for a wellness and we renew her meds for chronic conditions, would we bill the additional problem visit as well? Is it appropriate to renew medications during a wellness exam?

Thanks!
 

Chelle-Lynn

True Blue
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It is appropriate to renew scripts for medication during a wellness visit. As to whether or not an E&M (99212-99215) can be billed in addition to the wellness visit would be based on the documentation. In order to meet the criteria for an additional E&M code with modifier 25 the services related to the "sick visit" would need to be able to stand on its own and meet the minimum requirements for 2 out of 3 components for the established E&M.

Most often, during the course of a wellness visit a physician will determine that a patient is doing well on their medication and renew or make slight adjustments to an on-going prescription(s). This in itself would not warrant an additional E&M as this would be considered a part of the assessment of the well visit and maintenance of the patient.

As always the final determination comes down to the documentation.
 

sjack

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Documentation tool for providers?

I have new fresh out of medical school provider who insists that he should be able to bill for an annual wellness exam on the same day as a 99214 for chronic conditions that he considers and/or treats. I explained that it is rare to have a 99214 and wellness for chronic conditions but that his documentation is the determining factor. He asked if I have a reference tool to give him for education. I referred him to the CPT book and cms.gov but he wants something more straightforward. What have you found to educate providers that is concise but accurate?
 

Chelle-Lynn

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Like you noted, it is not common that a patient would be in for a well visit at the same time they have a sick visit that levels to a 99214. There is no rule against it, but from a common sense perspective it would be difficult to provide a sick patient with a wellness exam.

Generally what you will see during a well visit is that the patient has a number of chronic conditions that the provider will note. Such as diabetes, hypertension, etc. It would be appropriate to list them in the assessment section of the notes as part of the wellness visit. They would address the status of the condition and to make minimal adjustments to medication, etc. Such as diabetes well controlled and an adjustment to their prescriptions. This by itself would not warrant a sick visit but it is appropriate to reference the condition as part of the documentation.
 

Quaker

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Chelle-Lynn,
My providers feel that it best practice to schedule AWVs at the same time the patient is due for their medically necessary chronic condition follow-up visit (eg, 6 month chronic condition visit) for patient convenience. Patients do not want to come in for 2 separate visits. Our providers perform both the AWV and chronic condition visit on the same day and provide separate notes for each visit. To support the separate E/M visit, they specifically address each chronic condition, recent labs, examination and provide medical management (even if it is just renewing medications because conditions are deemed stable). Are you in agreement with this practice or do you consider the MN chronic condition visit included in the AWV? Do you have any concrete guidelines to support either way?
Appreciate any feedback you can provide. Located in Pennsylvania and Novitas has no specific guidance on this topic.
 

Chelle-Lynn

True Blue
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Modesto, CA
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As long as the documentation supports both services then you are ok to bill both. Often times providers will do both as you said for the convenience of the patient. Make sure to review the records and work with your providers to ensure that they are providing you with the needed documentation and are not duplicating for example the exam on both the well and sick visit notes.

But yes, this type of care and coding is appropriate.
 
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