I'm wondering if anyone can shed some light or provide direction for me regarding what can or should be addressed during a patients preventative medicine exam
I understand the difference between a Medicare AW exam and the age appropriate exam CPT codes 99381-99387 and 99391-99397
My query lies with the later the none Medicare exam
Components include appropriate history and exam with preventative counseling based on age as well as risk factor reduction,Immunizations and diagnostic's
Where the water gets muddied for me is when the patient has long term chronic problems which are all brought into the encounter as well.
Is it necessary ? to discuss the pt's COPD ,NIDDM , sarcoidosis etc during their preventative medicine visit ,assuming all conditions are stable at the time of the visit and if so to what extent
Understanding that if there is a significantly problem or abnormality found or discussed such as an exacerbation of the pt's COPD that would be addressed with an E&M.
What I want to be sure of is it necessary to address all comorbidities during a preventative visit with a separate assessment and plan for each
Obviously the patients entire health picture is taken into consideration for counseling etc however the focus sometimes shifts from preventative a follow up visit on the chronic problems Not to mention the extra time spent addressing each co morbidity
If anyone can provide insight or recommend literature to research I would appreciate it
Is there a way to bill for extended Preventative visit when the provider addressed several stable chronic medical problems,as they can be quite lengthy

Thank you in advance Cheri