Wiki Well Visit and E/M

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AmandaM2153

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Can someone please define the lines between a well visit and an office visit.

I have patient's coming in (scheduling for the annual wellness) but when they get in the doctor dictates a review about other symptoms/conditions that they may have already had, or new conditions/symptoms that may arise.... Where is the line to not charge for the wellness and instead go with a office visit code???
There is never enough documentation for the wellness visit to code both either.

And if the situation does come up where you cannot bill for wellness, how do you explain it to the patient's?

Thank you anyone in advance for the help!!!!
 
AS PER CODING EDGE , MARCH 2012.
Medical Necessity should determine services and coding.
During a well visit the patient address problems that they are having above the normal well visit. The Provider orders labs and testing to be done to address the new symptoms, then you can bill and E&M with the prevenitive visit. That said if a portion of the history or exam are done for the well visit, the same work should be done for the problem visit, plus addition work for the problem visit. The provider must clearly define the problem oriented history -exam, as well as the preventive for both services. All addition work above and beyond the well visit should be used to calcuate the E&M.
 
Thank you for the information!!!


So now one more question - what if a patient schedules for a well visit, but the doctor documents more for specified issues, and only has like one line related to well visit - but does a history and ROS.. what would you take that as?

Say they had GERD, hip pain, hyperthyrodism, RLS, hypercholesterolemia - all of which are fully documented and reviewed (all in a number format; 1, 2, 3). then after that there a is #6 GYN EXAM
Wants this updated to day. Mammogram is up to date. Pap smears has been normal. No other female issues. Vagifem helping with vag dryness.

That's ALL for documentation on the well visit.
 
Have you read page 35 in the CPT manual? That may help. You can bill for preventative and an OV (99201-99214) if you can split the service...for example meet your requirements for a preventative visit and meet the requirements for all the components to level and justify putting mod 25 on the ov code. I evaluate the chart and by the guidelines on page 35 determine my justification from that.

Hope this helps!
Lynda Wetter, CPC
 
We inform the patient that they are here for their annual wellness visit, and if they have current medical issues they want addressed, then their visit is changed to a sick visit and the wellness exam is rescheduled, or vice versa. Basically they cannot have both on the same day. This is not a coding rule, this is our rule, because it's just too confusing and too complicated to make sure that all documentation for the AWV and a sick visit is documented properly. This rule has made our lives a whole lot easier! Thankfully, we have not had any negative push back from our patients on this.
 
Wow I really like your idea of informing them of that. With the way that these patients have been calling me about this it is getting ridiculous - and you know most of them scheduled the well visit thinking it would be fully covered and waited for their other "issues" until then so they didn't have to pay..... and then get mad when it gets charged as an office visit.... UGHHH

Thank you for the ideas!!! I think I am going to try and get that going in our office!!!!
 
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