Wiki Lab/Test Results Discussion Follow-up Visits

[rstroup]

Good afternoon,

A patient comes in for a wellness visit, no problems reported by the patient, doctor orders usual lab panels. The patient comes back a week later to discuss abnormal lab results. The provider documents a new diagnosis of Mixed Hyperlipidemia and Prediabetes but conversative management only with diet and exercise. No additional workup or testing is ordered. Is this a billable visit since these are new diagnoses or is the review and management of abnormal lab/test results part of the wellness the same way it would be with a problem-focused visit?

Thank you,

--
Ryan Stroup, CPC

 

[csperoni]

I consider this LIKELY a billable visit. There is evaluation and MDM done which is not part of the wellness visit. I will note the documentation is key (as always).
Note example 1:
Pt here to discuss abnormal test results. Elevated chol panel & HgA1C. Pt told to watch what she eats and move more. RTO 1 year.
Note example 2:
Pt here to discuss abnormal test results.
Findings of elevated LDL and triglycerides, very similar to 1 year ago at previous PCP. HgA1C of 6.3 indicating pre-diabetes; prior level 6 months ago WNL at 5.6.
Educated patient about low cholesterol and lower carb diet to include at least 5 daily servings of vegetables and limit fruits to whole and fresh (no juices, no dried). Discussed lean protein and fiber intake recommendations to regulate glycemic control. Reduce or eliminate processed and/or fatty meats. Avoid added sugars to food and beverages. Whole grains and complex carbohydrates will slow blood sugar spikes.
Exercise a minimum of 3x/week for at least 30 minutes. Exercise should be strenuous enough to raise heart rate to target goal. Encouraged joining a gym for classes with a friend, or other team/group activities like pickleball or water aerobics to stay motivated. Exercise has been proven to help manage blood sugar spikes.
American Heart Association handout and recommendations discussed. Pt had concerns as her MGM was diabetic which caused many additional medical issues including stroke and neuropathy. I explained to patient her current slightly elevated HgA1c is a warning sign and can be reversed and hopefully treated before progressing to DMII. Careful monitoring and symptoms discussed to catch any changes early. All questions answered.
Conservative management at this time. RTO 6 months for re-evaluation.
In example 1, I really don't see any significant MDM being made and would consider that work part of the test result. Example 2, I would certainly bill.

 

[rstroup]

Thank you @csperoni, that was very helpful! There has been a significant amount of discussion among my team surrounding this particular subject and whether or not we can bill for these visits. My understanding seems to align with your advice.

--
Ryan Stroup, CPC

 

[commitsvs]

Hello Csperoni,

Can please help me with this,

1)During their wellness visit (Pediatric/Adult), the patient does not mention any issues and the doctor orders the usual lab panels outside the office. After a few days or weeks, the lab results will be shared with the provider. There are no abnormalities in the results. Is E&M code (CPT 99212) a billable code in this scenario.

2) A patient comes in for a wellness visit (Pediatric/Adult). No problems were reported by the patient. The doctor orders the usual lab panels outside the office. After a few days or weeks, the lab results will be shared. There are no abnormalities in the lab results, but the doctor prescribed a multivitamin during the same visit. Can we bill E&M code (CPT 99212) for this scenario.

3) In the event that E&M codes cannot be used, what CPT codes can be used? The doctor must let the patient know about the lab result through an office visit or phone call, or text message. Are there any alternative CPTs to bill for this scenario. (Can we bill Tele Med CPT code).

4) The majority of my time is dedicated to HealthFirst, Medicaid insurance, Fidelis Healthcare, and other commercial insurance. If we bill Telemedicine CPTs for these cases, Health First and Medicaid will not cover the Telemedicine code. Please let me know what can be done in such cases.

Thank you in advance .