# Preventive exam and E&M on same day



## sknapp56 (Jun 16, 2011)

If a woman comes in for her annual wellness exam and wants to discuss infertility, the physician counsels patient can you bill a separate E&M code? I feel if she is of child bearing age this counseling should be included in the Preventive code. Any help on this issue would be appreciated. Thank you in advance.


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## Ivonne C. (Jul 1, 2011)

From my understanding, coming from an auditors point of view, If the physician counseled the patient extensively about the infertility treatment options, which would indicate he went above and beyond the typical counseling that is involved with a well woman visit, that visit is billable. two things to keep in mind-

Time spent counseling has to be documented and preferably documented on a separate note from the well woman to differentiate the two.

Personally I would bill for the well woman, and if the patient has questions regarding infertility either briefly address them, or set up another office visit to address her concerns

Hope this helps, 
Ivonne, CPMA


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## preserene (Jul 15, 2011)

Can briefly address it for the sake of not turning her wish down, but cannot be billed with preventive, I believe.
The physican can even say no counseling done but can give an appointment.

 How can this be coupled with preventive exam visit for billing?The term comprehensive in preventive exam does not mean the encounter problem has to be comprehensively addressed too.  It has to be seen in another/separate encounter with another appointment. It is  a speciality of its own- a sub speciality in GYN and an unique condition which runs for years even.
Infertility cannot be underestimated to a low level visit nor it can be elevated to a very  high level in relevance to risk factor/ life threatening MDM.  But the work-up,  is very tedious heavily demanding many  months to complete, including history and exam, can be quite extensive, as well as complex medical decision making, involving ordering additional testing and discussing different courses and phases of treatment.
 It is not wrong on the part of the patient who is curious enough and value it as the only botheration of health she has to address with and so she wants to make use of her annaual visit with this encounter. But Physician knows pretty well this cannot be combined with preventive exam.  
Basically having a conversation with the patient about her infertility alone will not complete the infertility management. infertility is not straightforward nor one step/two step/three step management and it involves with various specialty consultation. These type of visits can result in lengthy, complicated counseling sessions. 
A proper infertility counseling cannot be claimed without time factor getting involved or  a battery for diagnostic investigation ordered, meaning it is a complex time consuming, and to be addressed for a pretty long period even months to arrive at a proper diagnostic  criteria/value.


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## sknapp56 (Jul 20, 2011)

Thank you for your help.


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