Depends on what the meaning of Physical is --> RE: physicals in the medicare population and fraud

[Guest guest]

I know what you mean, Soma.

Most of my patients feel a physical means -- review all my 10 complaints and

get everything updated and referred and labbed up.

Technically, it really should be more of a preventive exam with review for

red flag symptoms, counseling, etc -- IMHO

Sometimes I will tell a patient that he has so many problems that I convert

the visit into a Level 4 visit instead of the physical.

Locke, MD

Re: physicals in the medicare population and

fraud

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

>

>

> .

>

>

>