Wiki "Physical coding"

[TLC]

I need help, what can you do when a doctor does a physical on a patient however he only wants to charge a 99213/99214 since he doesn't feel that the appt was worthy enough for the physical code. Time spent with patient wasn't but maybe 15min to cover problems. We are of course having problems with copays(or ins not wanting to pay for a E/M code charge when the patient was in for a physical) for ppo's and hmo's if the patient is entitled to a physical with their insurance but the doctor doesn't use the physical codes. any ideas? Thanks

 

[mitchellde]

The preventive E&M codes are not time based codes. If the patient presents for a preventive encounter then you should use the V70.0 dx code with the appropriate preventive E&M code. The patient that has preventive benefits will appreciate this, and you cannot charge one way for some and a different way for others.

 

[TLC]

physical

Thank you,, and doesn't the "physical" include dx's for ongoing problems,,diabetes,hypertension,hyperlipidemia etc,

 

[mitchellde]

yes it does