Orthocoderpgu
True Blue
Patient comes in for a routine exam. Patient also has Asthma and high blood pressure. Since the patient was treated for a significant medical condition, this is no longer a "Routine" office visit: right?
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki How to code Routine exam, medical findings
- Thread starter Orthocoderpgu
- Start date
dmaec
True Blue
Hi quinnwebb,
I haven't read the documentation but just going by what you posted it appears the asthma and high blood pressure are "chronic" conditions, if so - it's still "their" routine physical - I'd still code it as a preventive service. I wouldn't split bill a preventive and an E/M level unless the asthma and high blood pressure are "new" issues now being found and treated. And documentation can support both services. But, just because a person has health issues, doesn't mean it's not a routine physical.
{that's my opinion on the posted matter}
I haven't read the documentation but just going by what you posted it appears the asthma and high blood pressure are "chronic" conditions, if so - it's still "their" routine physical - I'd still code it as a preventive service. I wouldn't split bill a preventive and an E/M level unless the asthma and high blood pressure are "new" issues now being found and treated. And documentation can support both services. But, just because a person has health issues, doesn't mean it's not a routine physical.
{that's my opinion on the posted matter}
Christine Bekker
Contributor
- Messages
- 16
- Best answers
- 0
Christine Bekker, CPC, CPC-I
2008 CPT guidelines state; "If an abnormality/ies is encountered or a prexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem/abnormality is significant enough to require additional work to perform the key service, then the appropriate Office/Outpatient code 99201-99215 should also be reported. Modifier 25 should be added to the Office/Outpatient code to indicate that a significant, seperately identifiable Evaluation and Management service was provided by the same physician on the same day as the preventive medicine service."
Chronic has nothing to do with it, what is important is was there a seperate HPI, ROS, possibly a seperate exam for the problem, and scorable MDM, then you have met the guidelines to charge for both.
The guidelines do go on to state that if the problem/anormality does not require aditional work and the performance of the key components (Hx, Exam, and MDM) then the problem-oreinted E/M service should not be reported.
If your payor denys the two codes together you should always appeal the denial with a copy of these guidelines from CPT.
2008 CPT guidelines state; "If an abnormality/ies is encountered or a prexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem/abnormality is significant enough to require additional work to perform the key service, then the appropriate Office/Outpatient code 99201-99215 should also be reported. Modifier 25 should be added to the Office/Outpatient code to indicate that a significant, seperately identifiable Evaluation and Management service was provided by the same physician on the same day as the preventive medicine service."
Chronic has nothing to do with it, what is important is was there a seperate HPI, ROS, possibly a seperate exam for the problem, and scorable MDM, then you have met the guidelines to charge for both.
The guidelines do go on to state that if the problem/anormality does not require aditional work and the performance of the key components (Hx, Exam, and MDM) then the problem-oreinted E/M service should not be reported.
If your payor denys the two codes together you should always appeal the denial with a copy of these guidelines from CPT.
dmaec
True Blue
Christine Bekker, I couldn't have quoted better myself 
""The guidelines do go on to state that if the problem/anormality does not require aditional work and the performance of the key components (Hx, Exam, and MDM) then the problem-oreinted E/M service should not be reported.""
which was my point exactly -and from what was posted, it doesn't appear she has enough to support two services.
again, my point was - if the patient has chronic conditions that are simply "the same as always",...no, I would not code two visits - if they were newly found conditions - (or let me add here to clarify; chronic conditions causing issues again) then yes, documentation supporting ... I'd code both services.
I'd have to disagree slightly on the chronic not having anything to do with - I feel it does - because, if it's chronic - and nothing has changed, you wouldn't have enough to code a separate E/M with the px - however, if it's chronic and causing issues again, you might - and, if it's "new", not chronic - you most likely would have enough to support both services...
{that's my opinion on the posted matter}
""The guidelines do go on to state that if the problem/anormality does not require aditional work and the performance of the key components (Hx, Exam, and MDM) then the problem-oreinted E/M service should not be reported.""
which was my point exactly -and from what was posted, it doesn't appear she has enough to support two services.
again, my point was - if the patient has chronic conditions that are simply "the same as always",...no, I would not code two visits - if they were newly found conditions - (or let me add here to clarify; chronic conditions causing issues again) then yes, documentation supporting ... I'd code both services.
I'd have to disagree slightly on the chronic not having anything to do with - I feel it does - because, if it's chronic - and nothing has changed, you wouldn't have enough to code a separate E/M with the px - however, if it's chronic and causing issues again, you might - and, if it's "new", not chronic - you most likely would have enough to support both services...
{that's my opinion on the posted matter}
Orthocoderpgu
True Blue
Thank you both for your responses. They have been a big help. Thank you !