# Pt Refuses NP examination



## malynch (Aug 30, 2011)

I have a patient that is refusing to have the physicial exam as part of the NP visit.  I've not experienced this before so I'm not sure how to handle this.  I realize I can't bill the insurance for a NP visit without ALL 3 key components statisfied - one of which is the physical examination.  

Any suggestions?!?!?!?

Thanks!


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## penguins11 (Aug 31, 2011)

I would talk to the dr about discharging the patient from the practice.  How can the dr adequately examine the patient without a physical exam?  If they refuse the exam, they are going to be extremely difficult.  If there is some reason that they refused the exam he could document this, but this is a very strange situation.


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## MnTwins29 (Sep 1, 2011)

*Another thought*

While you certainly wouldn't have any systems or body areas documented, does the doctor at least record vitals, general appearance and such so that at least a constitutional exam is documented and you could use is as a PF exam and meet 99201?    Although I do have to agree that this certainly would raise a red flag to the MD and the practice as to the type of patient this person will be.


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## LLovett (Sep 1, 2011)

You can bill based on time regardless of the key components if the time requirements are met.

The other option you have is to use an unlisted code and the patient will most likely get stuck paying for it. I would just make sure the documentation supports that the patient refused the exam since you will have to send in documentation to the carrier when you use the unlisted code. Either 99429 for well care or 99499 for a problem visit.

Laura, CPC, CPMA, CEMC


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