When you address a medical problem during a CPT preventive medicine visit or Medicare wellness visit, it takes more time, but you can often bill for both. Here are some tips for combining visits without throwing off your schedule for the whole day.
1. Surface any medical issues up front. Have staff ask patients with upcoming preventive/wellness visits if they also have medical issues that need to be addressed. This step can occur when staff are scheduling or confirming preventive/wellness visits, allowing you to block off more time if necessary.
2. Be aware of rules about how often preventive/wellness visits can be billed. Sometimes, during a problem visit, you’ll want to squeeze in a preventive service as well, but first make sure the patient is eligible. Medicare wellness visits must be separated by at least 12 months, whereas CPT preventive medicine visits can be billed once per plan year (usually a calendar year, but some plans vary). Having staff check eligibility for Medicare wellness visits using the HIPAA Eligibility Transaction System can help you avoid denials.
3. Educate patients on out-of-pocket costs. Patients who know their preventive/wellness visit will be covered with no deductible or co-pay may mistakenly assume that all services provided during that visit will be no cost to them. It is best to let patients know up front that performing an E/M service with a preventive or wellness visit will result in the same co-pay they would incur if the problem-oriented visit was on a different day. Posting informational flyers in the exam rooms or waiting room is one method.
4. Schedule another visit if needed. It’s OK to ask the patient to return for another visit if it’s clear that a medical problem cannot be adequately addressed during a preventive/wellness visit. Emphasize that it’s for the patient’s benefit: “I just want to make sure we have enough time to address this concern thoroughly.”
Read the full FPM article: “Combining a Wellness Visit With a Problem-Oriented Visit: a Coding Guide."
Posted on Feb. 15, 2022 by FPM Editors
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