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clarification on billing an annual physical or AWV with an E/M

  1. Default clarification on billing an annual physical or AWV with an E/M
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    Please help me. I know that it's possible to bill an E/M along with a physical. I'm having trouble reading the documentation to find "separate and identifiable E/M within the physical documentation. To make matters worse, my docs use a smart set in EPIC which really eliminates a lot of information that might be there if they actually dictated. Does there have to be a completely separate set of documentation elements? Chief complaint, HPI, ROS, EXAM and MDM all separate from what is being done in the physical to bill an E/M?
    They are trying to bill E/M especially with the AWV because they feel like their patients illnesses warrant extra work other than the AWV, but they don't want to bill them for the 99397. I'm not seeing specific 'new' problems or exacerbations of chronic illnesses identified as reason for E/M or any MDM being done about it. What do I do?

  2. #2
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    Quote Originally Posted by aekukla View Post
    Please help me. I know that it's possible to bill an E/M along with a physical. I'm having trouble reading the documentation to find "separate and identifiable E/M within the physical documentation. To make matters worse, my docs use a smart set in EPIC which really eliminates a lot of information that might be there if they actually dictated. Does there have to be a completely separate set of documentation elements? Chief complaint, HPI, ROS, EXAM and MDM all separate from what is being done in the physical to bill an E/M?
    They are trying to bill E/M especially with the AWV because they feel like their patients illnesses warrant extra work other than the AWV, but they don't want to bill them for the 99397. I'm not seeing specific 'new' problems or exacerbations of chronic illnesses identified as reason for E/M or any MDM being done about it. What do I do?
    Wellness exams don't have HPI or MDM - those elements are unique to problem-oriented encounters. They're also the only portion of the exams that don't overlap. You should be able to assign a code based on the amount of HPI/MDM present. If you need help, let me know!

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