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Preventive and Problem E/M same day

  1. #1
    Question Preventive and Problem E/M same day
    Medical Coding Books
    I would like some opinions/advice. Our office has yet to bill both preventive with a problem visit the same day when documentation supports a sepaate E/M in addition to the preventive exam. Mainly, due to the fact that we have some patients who try to squeeze in a physical during their acute/chronic issue appt because their insurance did not provider preventive coverage, and so our physicians would provide both and bill out only one-and vice-versa...provide well child components while addressing my childs allergies-two for theprice of one. Needless to say, this creates seemlessly endless patient calls and complaints, I was there for my problem but you billed out a preventive and the most common complaint recently, my insurance covers an annual exam but you billed this as a problem visit. We must find a way to streamline this process, we can't continue to "guess" on what the patient wants billed. The appt frequently states follow up Diabetes/lipids/HTN and yearly physical exam--and the provider throroughly addresses the problems, ordering labs, refilling meds etc. To top it off, the CC will state follow up on chronic/acute issue and preventive exam. So, in reality both services are provided. The simplest answer in my opinion is to bill for exactly the service/services documented in the note-and in these cases that we bill both preventive and the E/M. I believe I will face some resistance to this, my physicians feel it is their choice to bill as they choose. However, that places us in a precarious position with the insurance company. How does your office handle this situation? Have things changed for you with the new Healthcare Reform? Our current suggestion to patients who ask us to change their problem to preventive (when documentation does not support preventive), is for future visit they should schedule a preventive exam only and schedule their chronic/acute issues at another time (their 3-6 month follow ups), to ensure that a preventive is documented and billed.
    Last edited by AR2728; 12-28-2011 at 02:56 PM.

  2. #2
    Concord, NC or Rochester, NY
    I would code and bill it according to what was done. I am sure there is a little leniency when it comes to existing problems - ie: if the md is checking the diabetes and writing a script, this may not warrant a separate and identifiable problem so depending on the situation this could simply be part of the physical.

    I would book appointments according to what the patient wants and when they try to get a physical included in the appointment, it is time for the MD to stand up and inform them to book a physical as it is time consuming and the appointment did not allow for that type of service.

    the largest barrier you are going to have is the MD's to get this going.

    It might also be good to inform patient's about the policy you have in your office so they are not confused.

  3. #3
    Columbia, MO
    for ICD-9 to address a chronic issue such as diabetes is a part of the preventive and you can use the V58.83 with the appropriate V58.6x code to show the follow up for drug levels. For ICD-10 you cannot have other diagnosis listed for a preventive, you can lit the preventive with no current complaint or you can use the code for preventive with current complaint. But it has to be a complaint not a chronic problem. I cannot wait for ICD-10!

    Debra A. Mitchell, MSPH, CPC-H

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