Wiki Billing an E/M when patients come in to review testing results

[cm@rlin]

Is it acceptable to bill an E/M level of service when a patient comes in to discuss/review testing that was done? Should an E/M level 99211 be appropriate for billing, or should the visit be coded based on time spent counseling the patient? Currently, the provider is billing an established patient level of service, usually a 99213 or 99214. The provider documents a History, Exam, and MDM.

Any thoughts?

Thanks,
Cheryl

 

[Cheezum51]

Level 1 visits are usually used for visits handled by ancillary staff and not the doctor. If your doctor is documenting Hx, Exam and MDM, I would think a level 3 or 4 visit would be appropriate based on meeting the appropriate level of 2 of those elements. Remember that, under the 2019 CMS guidelines for E/M codes that the Hx elements from the prior exam can be "carried forward" to the follow up visit with the provider noting that they have been reviewed and recording any changes which may have occurred. If the pt isn't a Medicare pt, then you'd have to see if the carrier involved has adopted the changes CMS has put into place.

Tom Cheezum, O.D., CPC, COPC

 

[thomas7331]

I've often seen 'review labs' documented as a reason for visit, and I will generally let providers know that this does not adequately support medical necessity for charging an E&M visit. If labs are abnormal, the provider should document what the abnormality or problem is that requires the follow-up visit, so that the services performed at that visit are supported with a medically necessary reason and can be coded appropriately. If labs are normal, then there is really no reason to be having the patient return to the office or to be charging an additional visit - this is something that could easily be handled by a brief phone call instead.