I found the article “Documenting and Coding Preventive Visits: A Physician's Perspective” [July/August 2012] very interesting. My problem with “preventive visits” is that patients often expect to get refills for at least three other chronic medical problems (diabetes, hypertension, dyslipidemia, etc.) at the same time – and expect to not have to pay their copay because their insurer advised them to come in for their “free physical.” If I generate separate documentation to keep the two issues from getting bundled, the patient gets angry because then my office charges a copay. I can't explain to patients what a preventive visit is supposed to be, do the exam, process refills, and advise care for the whole next year in 10 minutes or less.
If a patient's chronic problems are stable and you are simply refilling medications, this should not be reported separately from the preventive visit. If one or more of these chronic problems is not stable and requires additional decision making beyond refilling prescriptions, a separate evaluation and management (E/M) code could be billed with modifier 25, and a copay might apply. Patient education is vital to correcting the misunderstanding that occurs when a patient is informed that he or she is entitled to a “free physical.” Patients often expect convenience in addition to this “free visit” and don't want to schedule another appointment if other issues arise beyond what is included in a preventive E/M service. If you are aware that a patient does not want to receive a bill for services provided during a preventive visit, it would be helpful to explain to the patient prior to the visit what will happen during that time and what circumstances may lead to additional charges. This avoids the uncomfortable situation where you might feel pressured to misrepresent what was done simply so that the patient will not get a bill.