Q: [Auto Liability] Is it acceptable when a patient comes in for an E/M that is auto-liability
(related to auto accident), but at the end of that visit expresses health related issues
that the physician addresses.
Is it OK to bill an E/M code assessed for auto to the liability company and an E/M code
to the health insurance for the health problems the same day?
A: The answer is absolutely yes.
I have asked this question at least 50 times over the years just to make sure.
Some doctors have issues with taking a lot of the information from the first part of
the exam and carrying it over and double dipping with thehealth insurance and it’s really
not how it works.
So, I wanted to cite an example so that you could have a visual.
It’s very similar to a patient coming in for a preventive exam, then talking to the
doctor about another problem and you can bill a preventive with E/M. Same concept, only
we’re dealing with two different insurance companies.
I always preface this as saying that I have never run into an issue where it’s unethical,
if the doctor’s documentation and the billing is done right, there’s always an exception
to the rule so you always want to make sure that if you have any questions to ask the
motor vehicle or the health insurance carrier.
But let’s assume an example that a patient had whiplash from a motor vehicle accident
and went to see the doctor, he said to come back a week later, and this is the follow-up
visit.
When he first saw the patient, it was just to give him a script, say for Motrin or something
like that and rest, and basically that was it.
Comes in for the visit a week later and the doctor really does a very limited history.
He reviews the elements of the complaints – how’s your neck – and the review of
system related to the injury.
Then, it’s coded as an expanded problem focused.
His exam was just, he didn’t even take vitals; he looked overall at the appearance of the
patient and he did a single system organ exam, which was the neck and the shoulders, musculoskeletal.
The patient had improved.
The established problem was improving.
He’s minimal risk.
No other treatment was necessary and the doctor said “Come back if you have any issues,”
but everything seems to be going OK.
When you just throw it all together, it comes up as a level II established patient visit.
I mean, this is definitely a synopsis, but he really just came in to check the neck,
and that was it.
At the end of this visit, he says, “Oh, can I talk to you about a problem I have?
I had a sore throat for a few days.
I feel like I have a temperature and this guy next to me was diagnosed with strep and
I was just wondering if you could check it out.”
So, now we’re talking about a whole different documentation and the complaint is a sore
throat, and so he goes through and asked all the questions, does the review of systems,
and the nurse comes in and she does the vitals.
She takes the temperature, blood pressure, everything that he did not do in the first
visit.
Then, he went and he did the ears, nose, throat and checked all of that.
When he looked at the throat, he said, “I’m going to give you a quick strep test just
to make sure” and it came back positive.
Based on all the information and the documentation, it came back as a level 3 and he also did
a rapid strep test, which was an 87880-QW.
[Editor’s note: QW – A HCPCS modifier that means CLIA waived test.]That is totally,
if you looked at the notes, they’re totally different than what he documented for the
motor vehicle accident.
Really, the scenario could change in any way because if the visit was much more extensive
for the motor vehicle and then the patient brought up the sore throat, you really have
to weigh it out.
One thing they did say and doctors, I shouldn’t say this, but a lot of doctors are notorious
for billing like a level 5 for, say, the motor vehicle, taking all that information and dumping
it into the E/M visit and then billing another level 5.
If you do everything in one visit, you can document it and bring that forward to bill
the health insurance, but you may have to use time as a contributing factor and you
can definitely say in the note that certain things were done for the motor vehicle, but
you would probably implement, like you said the time or counseling, care, that nature
to bring it up to the level of service.
It’s really based on documentation.
But you can’t double dip so you want to make sure that all information all on the
same day but definitely separate and you should be fine.