Wiki Office Visit and Procedures - Full body exam

[AprilSueMadison]

Our patients generally get a full body exam every six months to every year. What I'm trying to determine by posting this is if my physicians aren't documenting enough. Obviously I'm not a doctor and all I know in regards to dermatology documentation is what they do...not what other doctors do.

A patient comes in with a lesion, it gets biopsied. If that is all that is done, then there is nothing more I can code. No office visit will be billed out.

If a patient comes in with a lesion, and asks for a full body exam though...if we document that they asked for a full exam would that constitute an OV? What if we documented that they had a history of serious sunburns?

Obviously history of skin cancer works if they have a history, but if they don't I'm not for sure where to go from there. Perhaps there isn't anything further they can document...but it doesn't hurt to ask what other doctors are doing and what you, as coders, are seeing. I feel like our doctors are missing something but I'm not for sure what.

 

[CatchTheWind]

If there is true medical necessity for doing the full skin exam (such as history of skin cancer), then theoretically you can bill an office visit. The problem you will run into is that some payers are very stingy about paying for it. We have found (particularly lately) that Humana and Florida Medicare will refuse to pay the office visit unless the provider happened to find some other new problem on the exam.

If there is no medical necessity, just a patient request, then this is a preventive service and the patient has to pay out-of-pocket for it (or you can provide it as a courtesy, since you're getting paid for the biopsy, which is what we do).

There have been some discussions in this forum about some carriers paying for FBE as a covered preventive service, but I do not know of any who will.

 

[AprilSueMadison]

Assuming an established patient....
Assuming we are looking for skin cancer (because that's what we all do)....

wouldn't it be relevant and necessary to do a full body exam on on a patient who works outdoors (in Florida or Texas for example) and has had multiple sunburns over the years?

I'm trying to work out this medically necessary part for the full exam.

But if they come in and just request it, then we can't get anywhere. We offer a free screening anyway so we often use that...I just need to make sure I'm getting them to document everything!

 

[laauserc1]

i have found that with NY MDCR, they will not pay for the skin exam this year even with a history of skin cancer. they are stating it is routine. but they will pay if there is a biopsy along with the office visit. I sometimes just dont understand them. Can you sit with the provider and voice your concerns? They may have an idea or two that may help.