Forum - Questions & Answers

Sep 13th, 2017 - sschwartz 4 

Annual Physicals

Is there a set rule for how many body systems are to be checked/examined during a yearly physical? I have a provider who will do just a pelvic and no other portion of a physical exam and I feel it would be wrong to code say a 99396 with nothing else having been examined.

Oct 4th, 2017 - ChrisW   256  1 

re: Annual Physicals

A comprehensive exam with Preventive Medicine is not the same as a comprehensive exam that is required with E/M codes 99201-99350.

The AMA guidelines state the extent and focus largely depends on the age of the patient. The exam should be more extensive if there are preexisting problems. If the problem is significant enough to require additional work and meets the key components of a problem-oriented E/M service, the appropriate E/M service should also be billed. In this case you would apply modifier 25 to the E/M indicating a significant and separate E/M service was provided on the same day as the preventive medicine visit.

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