I disagree with the carve out of a problem visit from a well care but I am not under Noridian so I can't really speak to that. WPSMedicare has described the carve out as only services that are "normally provided" during a well care visit. Which would be pap/pelvic and breast services that are covered by medicare. A problem visit is not normally included in a well care, joint injection is most certainly not normally included. These would be billed at the regular rate in additon to the well care codes.
I completely disagree with the policy they have put forward. This is just a way to get paid from medicare for a service that is not covered. If the intent of the visit was for a preventive visit then that is what should be billed. Just because the patient has other issues does not mean the preventive service was not done.
Top of page 40.
Hope this helps and good luck,
Laura, CPC, CEMC
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