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cdr4life

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It is generally understood that when billing for an additional E&M visit with a physical exam, one must document a separate HPI.
This makes good sense when the patient presents with an additional problem during a preventative visit (i.e. diabetes, cough, etc.).
However, how does one document a separate HPI for an additional E&M, which may require further work up and evaluation, when it is a finding which is discovered during the annual exam and not one that the patient presents with?
Example: Patient presents for an annual exam and the provider discovers that the patient has a serious arrhythmia which requires further work up, imaging, labs, referral, etc.
The patient did not present with this problem, there is no HPI that can be obtained, so how does one go about billing for the additional E&M?
 
Once OCt 1 is here and ICD-10 CM is implemented you will no longer be able to bill an office visit with a preventive. The ICD-10 CM codes for general exam contain an excludes 1 note for signs and symptoms, which states code to signs and symptoms. However if the provider has an abnormal finding without the patient stating a complaint, then it will be the same as it is now with the exception that the codes will state General exam with abnormal finding. However you cannot have a separate office visit when the reason for the encounter is a preventive and not for symptoms. IN MY OPINION, this is where you use the 33 modifier. Instead of billing the prevent E&M you bill a visit level for the entire encounter and append the 33 modifier, this will indicate that the patient has no copay and captures the encounter as a preventive.
 
Modifier 33 is not valid on E/M codes only surgery codes. A problem visit is not separately billable when the patient came in for a preventative exam, never complained of another problem, and the provider discovered the problem during the exam, regardless of what follow up is recommended.
 
That is not true the modifier 33 is to be used on any service that is not identified as a preventive but is performed for preventive services. No where does it state that it is a surgical only modifier. Even when it was introduced by the AMA in2010 the AMA gave examples of where it is used on EM services. They addressed the issue of the preventive with no problem expressed by the patient but discover by the provider, and indicated that this would be appropriate to use the 33 on an office visit, not an office visit with a prevent, just the office visit. These articles are on file in the AAPC data base
 
Here in Michigan, very few payers state wide will pay a preventive along with an E/M code for the same DOS. (Even with documentation to support a separate E/M) Something to think about... even with an appeal they are still denied. Best to check with each individual payer and verify their policy. A separate E/M code billed w/ a preventive is a "go" in the coding world, but in the reimbursement area many do not pay for both.
 
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