AAPC - Back to school
Results 1 to 3 of 3

Thread: OV in conjunction with Prevent Med visit

  1. #1
    Join Date
    Apr 2007

    Question OV in conjunction with Prevent Med visit

    AAPC: Back to School
    I have a physician who is charging out a Prevent Med code (99397) for a Medicare patient at the same time as an Office Visit (99214-25). Because of "carve-outs", I understand she is allowed to do this since she is also monitoring a couple of chronic conditions as well. My question has to do with the documentation. I told her she needs SEPARATE documentation for each code; she can't double-dip by using the HPI, ROS, and PE from one for the other. With the carve-out, she'll get a portion of the reimbursement, but since she's technically billing out both in full...documentation needs to be there. Any input on this would be greatly appreciated!!

  2. #2
    Join Date
    Apr 2007
    South Bend


    I am not aware that the documentation needs to be separate. If you have some documentation guidelines that state that I would be interested in reading them. I have doctors that "split bill". I believe you called it "carve out". Medicare does require you to subtract the problem visit charge from the preventive charge.

    CPT states: If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem or abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate code (99201-99215) should also be reported.

    Most of the time the physicians I work for meet the additional work in the history key element when working with chronic conditions and I just "count" the elements related to those conditions in history. It's hard to split a PE when it is suppose to be "comprehensive" in nature anyways. Again, usually if an abnormality in the PE is discovered than the provider would go back to history and ask additional questions, etc. regarding the abnormal finding. But this is the way I view the guidelines and how I apply them. I an interested in hearing others viewpoints.


  3. #3
    Join Date
    Apr 2007


    Thank you, Sandy, for your input...it is helpful. I guess it is in the way we as individuals interpret things! That's why it is a great tool, to have these forums. I believe what you said makes sense to me...and I am going to do a little more searching. I will most likely re-evaluate my position on this issue and determine how to further advise physicians who are billing this way. Thanks, again!

Similar Threads

  1. problem visit with prevent med
    By smros in forum Pediatrics
    Replies: 1
    Last Post: 09-22-2011, 12:16 PM
  2. problem visit along with prevent med
    By smros in forum Family Practice
    Replies: 1
    Last Post: 09-20-2011, 08:24 PM
  3. problem visit with prevent med
    By smros in forum Internal Medicine
    Replies: 1
    Last Post: 09-14-2011, 10:00 PM
  4. Prevent and Problem visit, help!
    By sarann28 in forum Auditing General Discussion
    Replies: 2
    Last Post: 09-29-2010, 03:37 PM
  5. Immunizations at the same time as Prevent Med
    By robertke in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-08-2007, 08:44 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.