Wiki PREVENTATIVE SERVICES??????? Please help

[NHAMBLIN010982]

we are having a huge issue with our Internal med and family med docs understanding when to bill for a prevent services vs E&M vs both. If a patient comes in and is scheduled for there annual ck up but during that ck up the doc also comments on ongoing issues such as HTN and refills meds or sends out to a specialist- does that still count a preventative? When does it change to the problem focused visit? Especially as the patient ages there are going to be ongoing problems- so should these problems not be addressed at the annual physical? Please help. CPT is unclear about what is required for the prevent codes and I think the line is very blurry when it comes to treating ongoing issues.

 

[melissa meader]

if you look in the cpt book on page 33 paragraph 3 it states "If a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem or abnormality is significant enough to require additional work up to preform the key components of a problem oriented e/m then the appropriate problem oriented code 99201-99215 should also be reported. Mod 25 should also be added to the office/outpt code to indicate that a significant, SEPARATELY IDENTIFIABLE E/M SERVICE WAS PROVIDED BY THE SAME PHYSICIAN ON THE same day
the PREVENTIVE SERVICE. The appropriate preventive medicine service is additionally reported.

 

[mitchellde]

Just commenting on chronic issues is really part of a preventive encounter, to check on things to be sure all is as well as it appears to be. However if the patient expresses a problem and if the problem is addressed and it does not take up the majority of the visit then you can bill both. If on the other hand the visit is more about a symptomatic issue then you have only the E&M.
I was once told something that really makes sense here and that is we must remember this is the patient's encounter, and they get to say why they are here. If they say they have no problems and are here for preventive then that is what it is, regardless of their coverage, if they express symptomatic issues then that is what changes things, but WE cannot MAKE the patient ill if they express they are fine.