Wiki Preventative medicine services? Please Help

[crberman]

Hello everyone,

I could use some help with something. I had a patient call me today to confirm her appointment for next week. She said that once a year she does not have to pay her copay if we bill it as routine. She has a commercial insurance. The only thing that I know of would be to code it as a preventative medicine service (99396), is this correct? Isn't this a physical code? We are a cardiology practice and this would be her 6 month follow-up visit. Would this even be appropriate for us to do? I have my doubts. Any help would be greatly appeciated.

Christine Berman, CCC, CEMC

 

[btadlock1]

Hello everyone,

I could use some help with something. I had a patient call me today to confirm her appointment for next week. She said that once a year she does not have to pay her copay if we bill it as routine. She has a commercial insurance. The only thing that I know of would be to code it as a preventative medicine service (99396), is this correct? Isn't this a physical code? We are a cardiology practice and this would be her 6 month follow-up visit. Would this even be appropriate for us to do? I have my doubts. Any help would be greatly appeciated.

Christine Berman, CCC, CEMC

The documentation has to support it. If the notes indicate that she was there for a well check, then you could use a code like 99396, and you might also be able to bill a regular office visit if a problem was also addressed - it'll just depend on the notes.

If she came in for a problem and the notes don't indicate that she had an 'annual exam' (or well check, etc.), then advise the patient that the records don't indicate that she had a preventive exam, so she would need to speak with the doctor to dispute his documentation. Whatever you do, DO NOT change the code just because the patient has asked you to. She's not the one that will get in trouble over it. Hope that helps!