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Thread: Physical with additional E/M

  1. #1

    Default Physical with additional E/M

    AAPC: Back to School
    I know that per CPT guidelines I am allowed to bill an additional E/M code with a routine physical if the visit goes above and beyond the normal routine care. However, the question is what is above and beyond a normal physical. I have a physician that will want to charge an E/M with the dx 401.9. This patient has been treated for a while for this problem. The same rx is renewed. No new treatment is done for this condition. What is the "additional work" that is required to validate the E/M? If someone could direct me to something in writing to present my case to my office, I would appreciate it.

  2. #2

    Default An answer....

    You would have to have all of the components (the H.E.M.) to be able to use another E/M for the office visit. If there is no additional workup on the patient for the problem then you should not use another E/M code. Just remember if you do indeed use an office code....sequence it first with a -25 modifier then the preventative maintenance code secondary.

  3. #3


    Does anyone know where I can get this information in "official" writing? I am positive this is being overused in our office, but I need something in writing to present to the office manager and physicians.

  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    follow the rules of an office visit, you need a chief complaint, reason for the encounter. A carry over from a same day preventive will not work as that is already part of the preventive. So what is the complaint? what is new being addressed? Since you are charge for 2 office encounters in the same day essentially, then what do you have that will cover a new and different ov that has not already been addressed.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Join Date
    Apr 2007

    Default Scheduling

    Can always note that there are specific patient face-to-face time expectations for each office code. A quick look at the sum total of coded services and actual time scheduled for a patient or patients may result in a discrepancy?

    I remind our providers that a possible audit could include a copy of a days schedule.

    Just a thought

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