# Physical with additional E/M



## nc_coder (Jul 7, 2011)

I know that per CPT guidelines I am allowed to bill an additional E/M code with a routine physical if the visit goes above and beyond the normal routine care.  However, the question is what is above and beyond a normal physical.  I have a physician that will want to charge an E/M with the dx 401.9.  This patient has been treated for a while for this problem.  The same rx is renewed.  No new treatment is done for this condition.  What is the "additional work" that is required to validate the E/M?  If someone could direct me to something in writing to present my case to my office, I would appreciate it.


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## kcope (Jul 7, 2011)

*An answer....*

You would have to have all of the components (the H.E.M.) to be able to use another E/M for the office visit. If there is no additional workup on the patient for the problem then you should not use another E/M code. Just remember if you do indeed use an office code....sequence it first with a -25 modifier then the preventative maintenance code secondary.


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## nc_coder (Jul 8, 2011)

Does anyone know where I can get this information in "official" writing?  I am positive this is being overused in our office, but I need something in writing to present to the office manager and physicians.


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## mitchellde (Jul 8, 2011)

follow the rules of an office visit, you need a chief complaint, reason for the encounter.  A carry over from a same day preventive will not work as that is already part of the preventive.  So what is the complaint? what is new being addressed?  Since you are charge for 2 office encounters in the same day essentially, then what do you have that will cover a new and different ov that has not already been addressed.


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## jackson7591 (Jul 8, 2011)

*Scheduling*

Can always note that there are specific patient face-to-face time expectations for each office code.  A quick look at the sum total of coded services and actual time scheduled for a patient or patients may result in a discrepancy?  

I remind our providers that a possible audit could include a copy of a days schedule.  

Just a thought


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