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E&M with Physicals Exams

  1. Default E&M with Physicals Exams
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    Question for those of you who are billing for preventative medicine services ( physical exams ) and also billing an additional E&M level for the same visit. Our facility has always done this, as long as the documentation supports it. Obviously, we have patient complaints that they shouldn't be billed for both. The Director of Revenue Cycles is curious if we "have" to bill for that additional E&M level? I think it is an unwise move to not bill for it as we are going to see a decrease in revenue, however, I am wondering if anybody has documentation on it being required. I know the CPT guidelines state the E&M "SHOULD" be billed in addition, but do we have to? It seems to me that if we were audited, we would be told we weren't billing correctly if we weren't using the additional E&M level when the documentation supported it. Any thoughts? I appreciate your help and your opinions

  2. #2
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    always code according to cms guidelines, p&ps, coding books, updates, workshops, etc....it's not your fault your employer is not educated enough.....however, if your employer gives a directive of what not to capture and what to capture after you and your employer go over the guidelines/documentation and stands firm in their decision, please follow the directive....make sure you know the correct way despite your company's decisions (I SPEAK FROM EXPERIENCE) and get coding insurance on yourself-you can find the insurance information under member benefits.

    Quote Originally Posted by jbolton View Post
    Question for those of you who are billing for preventative medicine services ( physical exams ) and also billing an additional E&M level for the same visit. Our facility has always done this, as long as the documentation supports it. Obviously, we have patient complaints that they shouldn't be billed for both. The Director of Revenue Cycles is curious if we "have" to bill for that additional E&M level? I think it is an unwise move to not bill for it as we are going to see a decrease in revenue, however, I am wondering if anybody has documentation on it being required. I know the CPT guidelines state the E&M "SHOULD" be billed in addition, but do we have to? It seems to me that if we were audited, we would be told we weren't billing correctly if we weren't using the additional E&M level when the documentation supported it. Any thoughts? I appreciate your help and your opinions
    Rachele Porter, AS, CPC, CPC-H, CEDC
    no weapons formed against me shall prosper

  3. #3
    Default New pt E&M and physical
    What is the correct way for coding a new pt. E&M same day as physical?
    Would both the E&M and physical code be new pt. codes or only one for New pt and one from established?
    thanks
    jennifer

  4. Default
    Hi there are always when PT come for Preventive and Dr. finds problem and start to treat. We both bill w/25 mod. The payment is up to carrier and pt's own policy. 50% denied, saying not allowed in the same visit. but 0ther 50% pays. There is alway documentation and ICD-9 to support.
    tks

  5. #5
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    Quote Originally Posted by jlalmond View Post
    What is the correct way for coding a new pt. E&M same day as physical?
    Would both the E&M and physical code be new pt. codes or only one for New pt and one from established?
    thanks
    jennifer
    once they're seen (new patient px) they're no longer "new" - so established patient for E/M. That's the way we do it, documentation supporting both services of course!
    {that's my opinion on the posted matter}
    Last edited by dmaec; 08-05-2008 at 12:06 PM.
    Donna, CPC, CPC-H

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