If a patient comes in for a annual exam and the provider refills prescriptions for an established problem can you bill out a separate E&M? We are split in the office as to you can or can't. We all agree if there is a new problem found and expanded work up done you can bill a separate E&M. It is just we disagree on if they have hpertension you come in for a physical and prescription is renewed you can charge an E&M. Just want to see what other offices are doing. Thank you for your help.
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Wiki Preventitive exam & E/M on same day
- Thread starter sknapp56
- Start date
nc_coder
Expert
I actually quit a job last year for this reason. The physician, office manager, and I just could not come to an agreement on this. I said, no, you should not bill the separate E/M for just a prescription refill. And they said yes, I had to. I agree, if there is a new problem, if treatment of a chronic condition is changed, a new prescription is given, or something of that manner, then the separate E/M is justifiable. I just could not explain to the patient's anymore that the doctor just wanted to bill it this way and that's the way it is.
I did a lot of research on this last year, but unfortunately all of that is still at the office I left. I had several sources to back me up on my reasoning for not billing it.
I did a lot of research on this last year, but unfortunately all of that is still at the office I left. I had several sources to back me up on my reasoning for not billing it.
philipwells
Guest
Assuming that on a date of service when the patient doesn't have an annual physical but needs a prescription refill do you file this service with insurance? I'm just asking because it doesn't seem like the physician is really doing anything other than refilling a prescription.
99211 is rather vague in its description, but could be of use. This isn't really an answer to your question as I'm wondering the same thing as you.
I'd probably vote the side of not billing for prescription refills. Curious to see other's responses for all my answers are assumptions.
99211 is rather vague in its description, but could be of use. This isn't really an answer to your question as I'm wondering the same thing as you.
I'd probably vote the side of not billing for prescription refills. Curious to see other's responses for all my answers are assumptions.
1formissy
Guru
Being on the "other side of the fence" I audit records and I see provider's who try and report EM services on the same day as a Wellness exam.
The only way the EM can be paid separately, is if the patient has a presenting problem, which requires a separate and identifiable service aside from the wellness exam. This is where the modifier -25 requires documentation support.
In regards to provider's re-filling Rx's, I would not pay for an EM code, unless the documentation reports a history, exam, and medical decision making. If the patient is strictly being seen for a Rx refill, the answer is no, you cannot bill an EM for this.
The only way the EM can be paid separately, is if the patient has a presenting problem, which requires a separate and identifiable service aside from the wellness exam. This is where the modifier -25 requires documentation support.
In regards to provider's re-filling Rx's, I would not pay for an EM code, unless the documentation reports a history, exam, and medical decision making. If the patient is strictly being seen for a Rx refill, the answer is no, you cannot bill an EM for this.
mitchellde
True Blue
ReFilling the current prescriptions is an integral part of am annual exam so there is no rationale to support an additional visit level.