Forum - Questions & Answers

Sep 3rd, 2013 - pams10

Prevetative Visit versus E/M

My supervisor tells me that she has an article that says a Preventative visit can be used, even though the Provider is managing multiple chronic problems, such as hypertension and diabetes. She says that the Preventative visit can be charged if there are no changes. I believe it should be coded as an E/M, as CPT® describes a Preventative visit as "asymptomatic"?

The issue is that the patient comes in once a year for a checkup and medication refills, and wants it coded as Preventative for insurance reasons. I want to be sure that isn't fraudulant.

Sep 3rd, 2013 - nmaguire   2,606 

re: Prevetative Visit versus E/M

Prevention= asymptomatic
E/M sick visits= management of chronic conditions, symptomatic illness and complaints, acute conditions. HTN and DM are chronic conditions.
You do not bill based on patient's insurance, you bill on medical necessity of presenting condition(s).



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