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Preventive med with E&M

  1. Default Preventive med with E&M
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    Should there only be one charge for a patient who is seen prior to school admission (special school for troubled teens)? We have a provider who would like to use a preventive med exam and an E&M, using V20.2, V40.3 and any additional dx the patient may have.
    My understanding for a school admission exam would be E&M with V70.3, although I realize that if they have not had preventive med within the last year this visit could be considered that. Shouldn't it be one or the other, but not both?

  2. #2
    Loveland, CO
    We fight our physicians on this all the time, however if the pt comes in for a routine exam, the CPT book states that an E&M code may also be reported if certain guidelines are met:

    "If an abnormality is encounter OR a preexisting problem is addressed in the process of performing this preventive medicine evaluation, and the problem or abnormality is significant enough to require additional work to perform the components of a problem-oriented E&M service, then the appropriate office/oupatient code should be reported with a modifier 25."

    This is stated in the info preceeding the preventive med codes. The documentation must support this: the physician must state he is seeing the patient routinely, and document in his note that he chose to turn his attention to evaluating a preexisting behavioral problem(in this case with V40.3).

    Hope this helps!

    Whitney CPC-A

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