physicals in the medicare population and fraud

[Guest guest]

It's an education in itself for patients to understand what a physical is. Even if they say they want a physical or a " check-up " or schedule as a physical, I would still charge a 99211-99215 E & M if it is truly a problem oriented visit. I just couch the chief complaint in (my own) terms of what they really are asking for... " Manage my diabetes... Refill my BP meds... Cholesterol, etc... " Most of these are really " Manage my several comorbid medical problems. " Now, if someone truly wants a physical, he gets a physical. I bet the person who got the 99215 for HTN, DM et al really did get a 99215 E & M (more likely 99214). If the correct amount of history, exam, and medical decision-making was done and documented, it's certain. What one CANNOT do is perform a physical and use the history, related exam bullets, and medical decision making, which is based on screening and prevention, to raise or affect the E & M level of a non-physical code. Jacques Guillot, MD

..

[Guest guest]

RE "I want a physical to manage my DM/HTN"

Careful -- some pts have different benefit plans. 1 price for the "well care physical" and regular (often with deductable) for regular care problems.

Once had a fellow yell and scream at me that his physical did NOT include by request review for his imitrex; felt like telling him that if not, then I wouldn't be writing for it (hadn't seen him before).

Matt

physicals in the medicare population and fraud

It's an education in itself for patients to understand what a physical is. Even if they say they want a physical or a "check-up" or schedule as a physical, I would still charge a 99211-99215 E & M if it is truly a problem oriented visit. I just couch the chief complaint in (my own) terms of what they really are asking for... "Manage my diabetes... Refill my BP meds... Cholesterol, etc..." Most of these are really "Manage my several comorbid medical problems." Now, if someone truly wants a physical, he gets a physical. I bet the person who got the 99215 for HTN, DM et al really did get a 99215 E & M (more likely 99214). If the correct amount of history, exam, and medical decision-making was done and documented, it's certain. What one CANNOT do is perform a physical and use the history, related exam bullets, and medical decision making, which is based on screening and prevention, to raise or affect the E & M level of a non-physical code. Jacques Guillot, MD

..

[Guest guest]

That's what I've been thinking. The generic term of

" physical " is loosely thrown around.

I have some patients who get a free yearly physical

with their plan (free meaning no co-pay) but then they

come in regarding management and diagnosis of multiple

medical issues requiring referrals to specialists,

electrocardiogram, etc... If I bill for an ECG with a

" physical " it won't get paid.

So, in reality, physical= no complaints.

Soma

--- Dr Levin wrote:

> RE " I want a physical to manage my DM/HTN "

>

> Careful -- some pts have different benefit plans. 1

> price for the " well care physical " and regular

> (often with deductable) for regular care problems.

>

> Once had a fellow yell and scream at me that his

> physical did NOT include by request review for his

> imitrex; felt like telling him that if not, then I

> wouldn't be writing for it (hadn't seen him before).

>

> Matt

>

> physicals in the

> medicare population and fraud

>

>

> It's an education in itself for patients to

> understand what a physical is. Even if they say

> they want a physical or a " check-up " or schedule as

> a physical, I would still charge a 99211-99215 E & M

> if it is truly a problem oriented visit. I just

> couch the chief complaint in (my own) terms of what

> they really are asking for... " Manage my diabetes...

> Refill my BP meds... Cholesterol, etc... " Most of

> these are really " Manage my several comorbid medical

> problems. " Now, if someone truly wants a physical,

> he gets a physical.

>

> I bet the person who got the 99215 for HTN, DM et

> al really did get a 99215 E & M (more likely 99214).

> If the correct amount of history, exam, and medical

> decision-making was done and documented, it's

> certain.

>

> What one CANNOT do is perform a physical and use

> the history, related exam bullets, and medical

> decision making, which is based on screening and

> prevention, to raise or affect the E & M level of a

> non-physical code.

>

>

> Jacques Guillot, MD

>

>

> .

>

>

>