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Thread: Exam required? OV requirements

  1. #1

    Lightbulb Exam required? OV requirements

    AAPC: Back to School

    I have a Uro provider that refuses to accept that an exam is required at all office visits, new and established. In the CPT book it states that history, exam and medical decision making are considered the key components in selecting a level of E/M services. This indicates to me that these are required. My Uro doc keeps telling me that Urologist's nationwide are not providing and documenting all three during established visits. Has anyone heard this before?

  2. #2
    Join Date
    Apr 2007
    Evansville Indiana

    Default exam

    For billing purposes:
    For a new patient you need 3 of 3 areas so an exam is required unless the physician has documented time spent and greater than 50% is in counseling and/or coordination of care. For an established patient only 2 of 3 areas areas required, so an exam is not necessarily needed, they could have history and MDM.

    Now, whether or not an exam is medically indicated is for the physician to determine.

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