Wiki E/M for med refill with preventive

[lhtgas]

Hello all.
I am currently working family medicine with the majority of the encounters being preventive with an e/m. My current understanding is that you cannot bill for both based on recurring labs for existing conditions, but you can for a new lab, or a new condition noted this visit. But when it comes to medication refills, I am getting contradicting information. One entity says you can, if the medication is being evaluated for appropriateness. Does "stable on medication" qualify for appropriateness? And then another entity says no, because unless the dose is being changed or the condition is new, that this would not justify a separate e/m. Does anyone have any clear, confident guidance on this? Thanks so much.

 

[lgardner]

I would not report an E/M on top of a preventive visit just for a medication refill. I would consider that to be routine and expected to happen during a preventive visit.

However, for an E/M (without a preventive visit), continuing an Rx at the same dose (refill) could count as prescription drug management, the medication must be listed, the dosage must be listed and the Rx must be linked to a diagnosis.

per Noridian:
"Credit is given for prescription drug management when documentation indicates medical decision making for the management of a prescription drug by the physician who is rendering the service. Medical management could include a new drug being prescribed, a change to an existing prescription, verification of any side effects or problems with the drug, or simply refilling a current medication. The drug and dosage must be documented as well as the drug management"

But again, I would not consider a refill enough to bill an E/M on top of a preventive visit.
ALSO, FYI, if an existing condition was exacerbated or there was a side effect of treatment and it is addressed and treated, that could count towards an E/M on top of a preventive visit.
it is not only the problem (new or established), but the treatment and management that counts.

 

[natashalage]

I agree with Igardner. You can also search your topic in this forum and you will find good information to your question (I remember reading about it a few times). One experienced coder in our forum said something like this 'In your note, cross out the documentation pertaining to the Preventative visit. Then, look what is left, if you have sufficient information for a separately identifiable E/M service. If yes, then bill for additional E/M. If not, then only Preventative visit."