preventive exam and E/M exam

Scenario:
51 yr female patient in for yearly exam, patient having some trouble with hot flashes. doctor discusses OTC meds for hot flashes and to follow-up with doc if not better. no labs drawn
doc wants to charge 99396 and 99212
I feel 99212 is not appropriate. discussion of OTC meds for hot flashes would not justify an additional visit
Thoughts??

Scenario:
2 month in for regular checkup, having some feeding problems, discuss other feeding options
doc charges 99391 and 99212
Again, don't agree
Thoughts??

re: preventive exam and E/M exam

The E&M exam/contact requires so much add'l information be used (Hx-CC & HPI; 1-5 Exam bullets; 2 of 3 MDM notations; etc) that I'm not certain the 99212 is validated? If the criteria are not met, the code cannot be used, and the CPT-E&M codes have a TON of criteria that needs to be met.

Others?

re: preventive exam and E/M exam

I agree with your original disagreement in both cases. To use 99212 in addition to the preventive exam a significant, separately identifiable issue must be taking place - in this case menopausal symptoms or hot flashes would be considered inclusive to the 99396 and so would feeding issues for the 2 month old. The documentation would need to clearly show that extra time beyond that allotted in the preventive service was used on resolving the problem / issue.