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OV in conjunction with Prevent Med visit

  1. #1
    Question OV in conjunction with Prevent Med visit
    Clearnace Sale
    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
    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
    Thank you, Sandy, for your 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!

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