Time based E/M with preventive

Can you bill a preventive visit and an E/M service on the same date of service when the E/M is based on time? Or, is all counseling done at a preventive visit considered to be part of the preventive service? Thanks for your help.

Counseling

Counseling during a preventive encounter is included in age-appropriate code. A preventive medicine service includes:
• A comprehensive history and physical examination
• Anticipatory guidance, risk factor reduction intervention or counseling
• The ordering of appropriate immunizations or laboratory/diagnostic procedures
• Management of insignificant problems
Age-appropriate counseling and discussion of issues common to the age group are included in the preventive medicine services.
Preventive counseling and/or risk factor reduction interventions that are provided at a separate visit/encounter should be reported with the preventive counseling codes. While the counseling varies according to the age of the patient, it generally includes such issues as diet, exercise, smoking cessation and sexual practices.

Time based E/M with Preventive service

Sorry, it's still a little fuzzy. Let me add, if an adult pt presents for a preventive visit and at that visit a new or worsening chronic condition is evaluated (e.g. migraines, sciatica, etc) can that "E/M" be billed on time if greater than 50% of the visit (1 hour) was spent counseling the pt about the migraines and/or back pain? Thanks. I appreciate your help.

E/m

if the physician also evaluates a new acute or worsening chronic problem at the time of a preventive visit, according to Medicare you can bill both. Use -25 on E/M code level. You say "billing on time", then you must consider the "Time" is above and beyond the preventive service and not related to preventive counseling (which is included in Preventive encounter for risk factor counseling).
Your documentation would have to be quite detailed to separate the two. Billing a high level E/M at same time as a preventive service will be denied or reviewed.

E/M time with preventive service

There is so much gray about when you can add an E/M service to a preventive service, and considerable variation in reimbursement policies by payers. The CPT book has only a short description.

Since the preventive services do not have typical time documented, I recommend that providers do not use time for the additional E/M code, but base it on the level of history, assessment and plan that is documented. Having said that, the preventive visit requires a ROS, PFSH and exam, (age and gender appropriate). The point isn't to allow the physician to be paid twice for the same work, but to allow the physician to be paid for additional work. When I audit these, I look at:

the patient's health status
level of HPI and ROS related to the problem
A/P related to the problem

I "audit" those as best I can, separating out the preventive parts.

There is nothing in writing that says you can't use time, but without typical times for the preventive, I don't see how to do it.