TEST YOUR SKILLS
Case Study
A
45-year-old established patient is seen for an annual physical exam.
The patient
is found to
have a few minor problems but nothing complicated enough to
warrant any additional time or "work-effort" for the over-all
visit. The focus of the visit was the annual exam. The examination
is followed
by a lengthy discussion regarding the findings, problems, risk
factors, and treatment options. The provider feels that he/she
has spent more
than the typical amount of time with the patient. He/she should
bill:
Answer: b
The patient presented to the office for an annual check-up, with no real complaints.
Although there were a few minor problems, there was no additional work effort
used to address the problems and the focus remained the annual exam. CPT defines
the Preventive Medicine codes to include counseling and anticipatory guidance/risk
factor reduction, so therefore it would not be appropriate to separately bill
for code 99401. Also, according to CPT definition, the Preventive Medicine,
Individual Counseling codes 99401-99404 are not to be used to report counseling
and risk factor reduction interventions provided to patients with symptoms
or established illness.
If the patient's problems had required significant work and time separate from the annual physical exam, then it would have been possible to bill for both the Preventive Medicine and the problem oriented E/M code for the same date of service. However, remember Medicare may be the only carrier reimbursing for the E/M problem visit rendered during the same visit that a Preventive visit is billed. Medicare will not reimburse for the "routine annual physical" (preventive visit). The majority of commercial carriers now reimburse for the Preventive Medicine (well) visit, but would not allow two E/M category services on the same day. It would be to the provider's advantage, if the patient has well-care coverage and that was the focus of the visit, to bill the Preventive Medicine code only. These codes generally carry a higher reimbursement than the E/M codes 99201-99215. Caution some carriers will deny one and allow the other. The one most often allowed and reimbursed is the code with the least value/allowable amount.
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