I have only audited preventive exams (annual exam visits) based on age, gender and counseling, not the components. However, per the description in CPT book, it states the E/M service includes a comprehensive history and examination appropriate for the patient's age and gender along with counseling and guidance for prevention of risk factors. Therefore, I'm in discussion w/another auditor that is saying since the provider did not document any family history (he did document past & social) that it does not warrant a preventive and she changed the level to E/M problem visit 99201-99215. I still feel it is a preventive as the provider is seeing her for her annual and going over chronic conditions, but no new 'problems' or issues. I would love your take on this....Your suggestions/comments are welcome!
In this forum thread feel free to post your comments and areas for discussion that you may have based on the weekly auditing and compliance tips from NAMAS.
2 posts • Page 1 of 1
Page 9 in the CPT book under Determine the Extent of History, the last paragraph says the preventive history is not problem oriented, requires no chief complaint, but does include a comprehensive ROS, and Comprehensive assessment/history of pertinent risk factors. For the PFSH it says it includes a comprehensive OR INTERVAL past, family, social history. Interval meaning: a period between two events or times, and this does not say that all three are required.