Wiki FQHC Dual encounters, what constitutes "significant additional work"

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ydnas7

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When working pediatric notes, as an FQHC we are allowed to bill for a dual visit "whenever a problem or abnormality (i.e., exercise-induced asthma, migraine headaches, otitis media, prescription management) is addressed and requires significant additional work to perform the required key components and is medically necessary". We have a note that is documented as "stable on medication, but on drug holiday for the summer. Gave mom instructions on how to restart medications". Can I get your thoughts on if this would fall under prescription drug management?
:confused:
What is a general length of time to which "restarting medication" is considered significant? Your input is greatly appreciated.
 
When you state a "dual visit" are you referring to a well child visit and sick visit on the same day?
 
If the only documentation on the medical records for this day visit is "stable on medication, but on drug holiday for the summer. Gave mom instructions on how to restart medications" then this alone does not justify the coding of an E&M in addition to the well child check.

In order to bill a sick visit and well visit on the same day, the documentation related to the sick issue would need to be able to stand on it's own;

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in order to level a sick visit. The note above does not support an additional E&M 99212-99215 above an beyond the well child check

We are an FQHC provider and often bill for both sick and well visits using the expectation above. Hope this helps!
 
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