# OV vs Physical exam



## redmond1212 (Feb 24, 2011)

Hopefully someone can help. I haven't bill Physicals in a while.  Example: Dr states pt comes in today for E/M of his medical problems. He states that he is feeling well & has no complaints. Rest of note is like regular visit note with no complaints or particular conditions address. after assessment/plan states health maintenence review in 1 yr or sooner if there are problems.

Any help is appreciated.

Thanks,

Patty


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## mitchellde (Feb 24, 2011)

It certainly sounds like a physical to me.


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## redmond1212 (Feb 25, 2011)

Thanks it did to me also.  Someone in the office stated that it should stay with the 99214 procedure code but use the v70.0 as the dx.  Has anyone ever done this?

Patty


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## mitchellde (Feb 25, 2011)

If that is because the patient does not have benefits for the routine physicial then that is wrong, you use the preventive.  If it is because it was set up as a problem visit yet the patient had no real complaint and it contained elements of a prevent then it is my understanding that this is where you use the ov level with a 33 modifier.  I would certainly ask the payer first on that.  I have yet to bill it nor do I know anyone else that has used this modifier.  But it sounds to me in your description this should be billed with a preventive code.


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## redmond1212 (Feb 26, 2011)

Thanks thats what I thougt but just wanted to make sure.


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## Hlutes (Feb 28, 2011)

I would have to disagree, if the patient came in initially for medical problems, then the physician would have had to address those problems first.  And in the A/P, indicated that those medical problems are stable, no change, or doing better.  In this situation, the physician could have billed the 99214, addressing 2 or more stabled conditions.  This takes the burden off the patient if his/her carrier does not pay for physicals.  Further, if the physician, feels that this is a routine physical, then his chief complaint would not have been "medical problems" - and would have indicated yearly exam with the "V" code as a diagnosis.
Hope this helps.

Thanks

HLutes.


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## mitchellde (Feb 28, 2011)

Hlutes said:


> I would have to disagree, if the patient came in initially for medical problems, then the physician would have had to address those problems first.  And in the A/P, indicated that those medical problems are stable, no change, or doing better.  In this situation, the physician could have billed the 99214, addressing 2 or more stabled conditions.  This takes the burden off the patient if his/her carrier does not pay for physicals.  Further, if the physician, feels that this is a routine physical, then his chief complaint would not have been "medical problems" - and would have indicated yearly exam with the "V" code as a diagnosis.
> Hope this helps.
> 
> Thanks
> ...


IF the patient came in with stated symptomatic medical problems then there would have been more than a statement of stable.  If the patient has existing comorbidities with no complaints and comes for a routine exam then this is a preventive.  Just because a patient has existing problems you cannot charge an ov code for the physician to address the patient's ongoing meds and such that is included in the preventive.  You can never release the patient form the "burden" of paying for their yearly exam.  This patient stated he is feeling well and has no problems.  Maybe he has existing issues and is here for his yearly and is telling the physician there are no problems and all is good with is current treatments.  Then this is a yearly preventive.


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