Primary Care Coding Alert

Question: One of our patients with hypertension came in for a four-month followup exam. He had no current complaints, but was returning under the instruction of our physician. Will Medicare pay for this office visit if I use the diagnosis from his previous visit (401.1, essential hypertension, benign)? Should I expect the patient to pay for the charges of this visit?

Virginia Subscriber

Answer: The situations you describe are quite typical. Medicare and many private insurers will pay for office visits for the continuing management of a patients chronic condition (e.g., hypertension). Many chronic conditions require frequent visits to monitor the illness appropriately. This is not considered a routine visit. You would need to take into account frequency limitations, if any, the carrier has placed on office visits for a specific condition. If the office visits exceed this limitation, get an advanced beneficiary notice (ABN) prior to providing the service. This will alert the patient to the fact that he or she may be liable for the charges.