Medicare Compliance & Reimbursement

You may still be able to bill a level-four E/M visit for a patient with abnormal test results. Myth: You can't bill an evaluation and management claim unless the patient has pain or some similar complaint. Reality: Sometimes it's test results that prompt a patient visit, not pain or even a complaint. A patient may come to a specialist or emergency physician because he or she has abnormal test results. Challenge: It can be a challenge to obtain four out of eight elements of the history of present illness (HPI) when the patient comes in with severe anemia, for example. The patient may say something like, "My doctor told me to come to the ER because my blood count is low." Often times these patients have no complaints whatsoever. And sometimes patients will simply say, "My doctor sent me here but I don't know why!'" The patient's medical decision-making is [...]