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.