I don't think any actual audit tools exist since what is included in the preventive care codes is so varied. Even with a patients the same age and gender, things addressed at each of their visits could be quite different. CPT explains that the codes cover an "age and gender appropriate history and exam" and that these are NOT synonymous with the comprehensive history and exam described in the E/M guidelines for other codes. The counseling is going to differ as well. A CPT Assistant article in July 2009 says in part......
"The codes for initial and periodic preventive medicine E/M services are categorized by patient age. This is mainly because the types of preventive services provided in these visits vary and are directly related to the age of the patient. For example, preventive medicine E/M services for a 28-year-old woman may include performing a pelvic examination, obtaining a Pap smear, breast examination, and blood pressure check. Counseling may be provided regarding diet and exercise, substance use, and sexual activity. A preventive medicine E/M service for a 13-year-old girl who is an established patient may include, a scoliosis screen, assessment of growth, development, and behavior, and review of immunizations. Anticipatory guidance may be provided to the adolescent regarding good health habits and self-care, including avoidance of drugs, alcohol, and tobacco, sexual safety, and other peer-pressure issues such as, how to reduce the health risks associated with sexual activity and the importance of educational activities and social interaction."
As for the 52, no I wouldn't think that would be an appropriate modifier, but that's just my gut feeling. I've certainly never read anything indicating that it would be. A patient either has a problem (i.e., medical necessity) or they don't (i.e., "a check up") and if they don't, then the visit is preventive care.
In the past, when I have audited a chart note that doesn't seem to be as comprehensive as I think it should/could be, I haven't counted it against the provider but I have used it as an opportunity to exchange thoughts on what they view as "comprehensive" and how that might differ on what I consider comprehensive.
Barbara Burgess, RN, CPC, ACS-EM, PCS
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