I'm new to this practice. The provider requires his patients to come in two weeks after the physical, for a review, to discuss lab and other results. They've been billing this visit as an office visit. Now, I have patients questioning this. As far as I know, this is a separate office visit and not global with the Physical.
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Wiki Billing office visit for physical review
- Thread starter maschneck
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creinhardt
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CReinhardt
There are no global days associated with a Preventative Medicine Service (PMS), only surgical procedures have global days. A PMS includes age/condition appropriate counseling. When diagnostice tests are performed in conjunction with a PMS service the physician can usually counsel the patient at that time, concerning the results. When labs are performed the patient must be notified of abnormal results much sooner than two weeks and normal results would not require additional counseling.
I would be concerned when the physician requires all PMS patients to return. Why?
From 2013 CPT E/M Guidelines, "When counseling an/or coordination of care dominates (more than 50%) the encounter with the patient and/or family,...then time shall be considered the key or controlling factor to qualify for particular level of E/M service...The extent of counseling and/or coordination of care must be documented in the medical record."
So, yes an E/M can be billed but if I was a patient I would question why another visit is required? Just so another encounter can be billed?
There are no global days associated with a Preventative Medicine Service (PMS), only surgical procedures have global days. A PMS includes age/condition appropriate counseling. When diagnostice tests are performed in conjunction with a PMS service the physician can usually counsel the patient at that time, concerning the results. When labs are performed the patient must be notified of abnormal results much sooner than two weeks and normal results would not require additional counseling.
I would be concerned when the physician requires all PMS patients to return. Why?
From 2013 CPT E/M Guidelines, "When counseling an/or coordination of care dominates (more than 50%) the encounter with the patient and/or family,...then time shall be considered the key or controlling factor to qualify for particular level of E/M service...The extent of counseling and/or coordination of care must be documented in the medical record."
So, yes an E/M can be billed but if I was a patient I would question why another visit is required? Just so another encounter can be billed?
Monika Liddle
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I agree, those services do not have any global periods. I would question why the provider is requesting the patient to come in just for test results which could be given over the phone.
That's what I thought.
Thanks so much for answering my question.
My doctor prefers to have the patients in for the results, as a follow up for the labs, so he can discuss and answer any questions. It's only him and one MA, so they don't have the staff to answer everybody's questions on the phone. He doesn't require them to come in for the second visit, but won't give any lab result information over the phone. He doesn't want to start that again, since it takes so much time.
Thanks so much for answering my question.
My doctor prefers to have the patients in for the results, as a follow up for the labs, so he can discuss and answer any questions. It's only him and one MA, so they don't have the staff to answer everybody's questions on the phone. He doesn't require them to come in for the second visit, but won't give any lab result information over the phone. He doesn't want to start that again, since it takes so much time.
Peter Davidyock
Expert
I will caution you that if you are doing this to Medicare recipients you have big problems. The size of the practices staff is of no concern to the patients.
With holding results and requiring patients to pay for an office to discuss results (especially if everything is normal) is unethical. There is no medical necessity for the visit and that is the overarching criteria for billing. You need to be very careful.
Your physician and your patients will be better served if you simply post a notice around your office stating that patients will only be contacted if there are abnormal results.
BTW: in your first post you stated he "Required" them to come in...In your last post you stated "He does not require" them to come in...Which is it?
With holding results and requiring patients to pay for an office to discuss results (especially if everything is normal) is unethical. There is no medical necessity for the visit and that is the overarching criteria for billing. You need to be very careful.
Your physician and your patients will be better served if you simply post a notice around your office stating that patients will only be contacted if there are abnormal results.
BTW: in your first post you stated he "Required" them to come in...In your last post you stated "He does not require" them to come in...Which is it?