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neic4123

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I am looking to get clarification on a NP Well Visit combined with a sick visit.

Example:

Patient new to area, has multiple chronic conditions that needs to be addressed. (Medication for ADHD, Depression, ect.) I have found lots of information for an established patient. I know that I would put mod 25 on E/M code. How would we meet the requirements using the same exam? The doctor would already be doing a complete exam on the patient.

Any help or clarification would be AWESOME. Thanks in advance for your help!
 
new patient preventive with problems addressed

You will want to look at what examination elements went beyond the typical preventive service for the child's age. While the preventive examination is described as comprehensive, it is not comprehensive as described in the E/M documentation guidelines. It is based on what is appropriate for the child's age and gender and for purposes of identifying any abnormalities (versus fully diagnosing and managing). If the visit is covered under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), check the specific payer's requirements regarding the examination. Typically, an extended examination of the affected body system/area and related systems/areas is counted toward the level of the problem-oriented visit.

Though it is permissible to report both the preventive and problem-oriented services as new patient encounters. The level of examination may limit the problem-oriented E/M to an established patient visit based on history and medical decision-making.

Hope that helps.
Cindy
 
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