Wiki AWV & E/M

[KoBee]

There is debate if an E/M is considered significant enough. Some coders feel there is really no treatment being done except a referral.

Patient came in for AWV and during the AWV, provider examined a lesion a patient is complaining about, and provider just referred patient to dermatology, no Rx or anything.

Is this enough to bill E/M with AWV?

 

[TBailey202]

I'd be iffy on this one as well. Did they notate a description? Advise that it could be this or that? Is time possibly documented outside of the wellness in regards to this specific issue?

If it was a straight up -- ehh, dunno- send to derm. I think the best you could do is a 99212 and that's potentially a stretch depending on what's documented.

My favorite tool is AAPCs e/m calculator. Try that and see what it gives you.

 

[csperoni]

I agree this is a possible additional service. Take the note, cross out everything that's part of the AWV and what do you have left? Does it warrant -25 to be SIGNIFICANT and separately identifiable.
Example of billable: Pt c/o lesion on left forearm getting larger over the past 3 months and sometimes itchy. States last week scratched so much, it began bleeding. Remote pt hx of SCC on right shoulder approximately 10 years ago. Exam: oval shaped dark lesion of left forearm with irregular margins 3.1cmx2.6cm. Due to history and enlarging size, referral to Mohs dermatologist. Reminded patient of proper sunscreen use, and to avoid scratching which could create infection.
Example of not billable: Pt c/o lesion on arm. Referred to to derm.
The first example demonstrates there was medical decision making above and beyond an AWV and would warrant E/M -25.

 

[lgardner]

if the referral is to "evaluate and treat", I would NOT consider it an E/M (above and beyond an annual visit). the provider is deferring the treatment to someone else.

that is not to say that a referral can never count, but it depends on the documentation and the medical necessity.