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FQHC Dual encounters, what constitutes "significant additional work"

  1. Red face FQHC Dual encounters, what constitutes "significant additional work"
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    When working pediatric notes, as an FQHC we are allowed to bill for a dual visit "whenever a problem or abnormality (i.e., exercise-induced asthma, migraine headaches, otitis media, prescription management) is addressed and requires significant additional work to perform the required key components and is medically necessary". We have a note that is documented as "stable on medication, but on drug holiday for the summer. Gave mom instructions on how to restart medications". Can I get your thoughts on if this would fall under prescription drug management?

    What is a general length of time to which "restarting medication" is considered significant? Your input is greatly appreciated.

  2. #2
    Default
    When you state a "dual visit" are you referring to a well child visit and sick visit on the same day?
    Chelle Johnson, CPC CPMA CDEO CEMC CPCO CPPM AAPC Fellow
    Billing/Coding/Credentialing/Auditing Coordinator

    20+ years experience in Medical Billing and Auditing

  3. Default
    Chelle-Lynn
    yes, that is a correct. I'm referring to a well child visit and sick visit on the same day.

  4. #4
    Default
    If the only documentation on the medical records for this day visit is "stable on medication, but on drug holiday for the summer. Gave mom instructions on how to restart medications" then this alone does not justify the coding of an E&M in addition to the well child check.

    In order to bill a sick visit and well visit on the same day, the documentation related to the sick issue would need to be able to stand on it's own;

    History
    Exam
    MDM
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    in order to level a sick visit. The note above does not support an additional E&M 99212-99215 above an beyond the well child check

    We are an FQHC provider and often bill for both sick and well visits using the expectation above. Hope this helps!
    Chelle Johnson, CPC CPMA CDEO CEMC CPCO CPPM AAPC Fellow
    Billing/Coding/Credentialing/Auditing Coordinator

    20+ years experience in Medical Billing and Auditing

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