alexkassien
New
I have one payer that sees preventative visits in a rolling 12 months and OBGYN and Family Practice aren't considered separately. Is it compliant to bill a regular office E/M if we receive a denial for frequency exceeded for the preventative visit and there is enough to justify a separate E/M? Here is an example:
1. Thoracic Outlet Syndrome.- Symptoms include neck pain, shoulder pain, headaches, paresthesias, weakness, loss of dexterity, hand coldness, finger swelling, color changes, unilateral hand pain, coolness, pallor, numbness, and early fatigue on one side.- Clinical diagnosis confirmed; conservative treatment options discussed, including massage therapy and TENS unit use.- X-rays of the cervical spine will be ordered for further evaluation. Min-Tran to be continued, and progress updates requested.- Prescription for tizanidine 30 tablets with 1 refill provided for nightly use as needed for muscle and neck tightness. Specialist consultation if additional testing is required.
2. Perimenopause.- Reports irregular menstrual cycles, consistent with perimenopause.- Reassured that this is a normal part of the transition to menopause.- No immediate intervention required.
3. Post-Traumatic Stress Disorder (PTSD).- Experiencing PTSD symptoms following her husband's severe illness.- Started therapy, which has been helpful.- Continued therapy recommended to process the traumatic events.
4. Health Maintenance.- Metabolic panel within normal limits, indicating no concerns regarding kidney function, liver function, electrolytes, or protein status.- Not on any medications for chronic conditions such as diabetes, high cholesterol, or high blood pressure.- Advised to maintain current lifestyle habits. Blood work will be ordered for next year.- Up to date on routine immunizations and screenings.
1. Annual physical exam
2. Screening for endocrine, nutritional, metabolic and immunity disorder- Comprehensive Metabolic Panel; Future- Lipid Panel With Reflex; Future
3. Radicular pain in left arm- XR CERVICAL SPINE AP LAT FLEX AND EXT; Future- tiZANidine (ZANAFLEX) 2 MG tablet; Take 1 tablet by mouth nightly as needed for Muscle spasms.
4. History of cervical dysplasia
We originally only billed for preventative, but in this case, it almost looks like we should have billed a separate E/M along with the preventative visit to begin with. Looking for guidance on compliance and accurate coding. Can I correct this to remove the preventative CPT and replace with CPT 99214 and still be compliant? Thank you!
1. Thoracic Outlet Syndrome.- Symptoms include neck pain, shoulder pain, headaches, paresthesias, weakness, loss of dexterity, hand coldness, finger swelling, color changes, unilateral hand pain, coolness, pallor, numbness, and early fatigue on one side.- Clinical diagnosis confirmed; conservative treatment options discussed, including massage therapy and TENS unit use.- X-rays of the cervical spine will be ordered for further evaluation. Min-Tran to be continued, and progress updates requested.- Prescription for tizanidine 30 tablets with 1 refill provided for nightly use as needed for muscle and neck tightness. Specialist consultation if additional testing is required.
2. Perimenopause.- Reports irregular menstrual cycles, consistent with perimenopause.- Reassured that this is a normal part of the transition to menopause.- No immediate intervention required.
3. Post-Traumatic Stress Disorder (PTSD).- Experiencing PTSD symptoms following her husband's severe illness.- Started therapy, which has been helpful.- Continued therapy recommended to process the traumatic events.
4. Health Maintenance.- Metabolic panel within normal limits, indicating no concerns regarding kidney function, liver function, electrolytes, or protein status.- Not on any medications for chronic conditions such as diabetes, high cholesterol, or high blood pressure.- Advised to maintain current lifestyle habits. Blood work will be ordered for next year.- Up to date on routine immunizations and screenings.
1. Annual physical exam
2. Screening for endocrine, nutritional, metabolic and immunity disorder- Comprehensive Metabolic Panel; Future- Lipid Panel With Reflex; Future
3. Radicular pain in left arm- XR CERVICAL SPINE AP LAT FLEX AND EXT; Future- tiZANidine (ZANAFLEX) 2 MG tablet; Take 1 tablet by mouth nightly as needed for Muscle spasms.
4. History of cervical dysplasia
We originally only billed for preventative, but in this case, it almost looks like we should have billed a separate E/M along with the preventative visit to begin with. Looking for guidance on compliance and accurate coding. Can I correct this to remove the preventative CPT and replace with CPT 99214 and still be compliant? Thank you!