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How would you Audit this?

  1. #1
    Question How would you Audit this?
    Exam Training Packages
    I am needing help with medicare preventative services. I understand that Medicare covers a "welcome to medicare" physical. and they are also covering a physical every 2 years (w/high risk being covered yearly??), and now with the healthcare reform as of Jan. 2011 they will cover them yearly. Until then lets say a pt comes into the office for an "Annual" visit when medicare is not going to cover the visit, how would you code that? here is an example visit:
    HT: 5'0''
    WT: 119
    BP: 160/92
    Allergy: NKDA
    CC: Annual
    HPI: 69 yo P2 PM no bleeding, no D/C

    Last Mammo: 2/2010
    Last Exam: 2/3/09
    Last Colonoscopy: 2008
    Last bone density: 11/18/08


    NECK: NL
    Breast: Sym
    ABD: Soft, NT
    UT: AV, NT
    CX,AD: no masses
    Rectal: no masses

    Hematest (-)
    UA: (-)

    Assess and Plan:
    SBE/ year
    Fosamax 70mg
    Gen Cx

    Codes billed:


  2. Default preventive medicine service
    an "annual" physical is an "annual" physical and is coded dependent on the age of the pt., etc. If a provider codes it as an office visit, it's fraud. Some providers, in the past, have done that so the pt. has no charges. I don't see any reason to give a Medicare pt. an annual physical. Typically, they have so many problems that they're being seen on a regular basis anyway. An "annual" visit is a waste of time and money.

  3. #3
    Thank you, I was wondering the same thing about the E/M visit. the pt signed an ABN so the pt was fully aware that the "physical" might not be covered. with the CC stating Annual and no other HPI I will relay my findings.


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