Optimizing Office Visits for Preventive Services #1

Kathy McCoy, MBA April 19th, 2012

1 Comment Latest by COMMENTOR NAME

During a highly informative webinar entitled Optimizing Office Visits for Preventive Services, coding expert and author Betsy Nicoletti, M.S., CPC offered concise tips and guidelines for coding and billing the various types of office visits

Medical billing professionals draw a sharp line between the coding for preventive services and coding for problem-oriented office visits. Clinicians, on the other hand, will tell you that the distinction is not so clear once you are in the exam room. How do you ensure you maximize reimbursement for each type of service, if they occur on the same day? Or DO you even provide them if you want to optimize your cash flow?

During a highly informative webinar entitled Optimizing Office Visits for Preventive Services, coding expert and author Betsy Nicoletti, M.S., CPC offered concise tips and guidelines for coding and billing the various types of office visits correctly, to maximize reimbursement. Her insights are extremely useful for any practices that routinely provide preventive services along with condition-focused health care.

Betsy began the webinar with an explanation of preventive services. The CPT book describes preventive services as a history and exam that is age and gender appropriate, but does not actually describe what services are “appropriate” by age or gender. Clinicians are instead referred to their respective medical society for those guidelines. Preventive services also include counseling on risk factor reduction and anticipatory guidance such as wearing sunscreen or child-proofing a household. And they include referrals for screening tests and immunizations – if you provide these services, you can bill for them as well.

Under health care reform, many patients will have first-dollar coverage for annual exams, without a co-payment or deductible. That’s welcome news for providers, since this wasn’t always the case before. Other preventive services you may be able to bill for include:

  • lab tests done in the office;
  • the administration of vaccines and the serum if you purchased it;
  • venipuncture;
  • and hearing and eye tests.

Note that coverage will vary by insurance plan – just because it is listed in the CPT book as a legitimate service does not always mean it is covered by a health plan.

Preventive services you may be able to bill for include lab tests done in the office; the administration of vaccines and the serum if you purchased it; venipuncture; and hearing and eye tests.

In terms of coding visits correctly, Betsy emphasizes that it is critical to ensure that the right visit type is noted at the time a patient makes an appointment. Whether using a paper chart or an electronic health record, getting the visit type correct up front allows the medical assistant to open the right template for documenting the services provided. It also allows the scheduler to allocate enough time for each type of visit.

In some cases, you may be able to bill for a problem-oriented visit as well as the wellness visit if you performed the key components associated with a problem-oriented visit that same day. Documentation is key here. The provider must note the symptoms and status in the history, and the assessment and plan actually must address the patient’s problem. In these cases, medical billers would use a 25 modifier on the problem-oriented visit.

In the webinar, Betsy also spends some time discussing the various types of wellness visits covered by Medicare. Check back for our blog on that discussion.  If you would like to find information on any other topics of interest, feel free to check our webinar archive. You can also join our notification list for upcoming informative webinars such as this one.

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