We have a situation where "preventive health care" and "preventive examinations" are scheduled for Medicare patients. Medicare denies payment, of course, and we are asked to code the visit to an established E&M code, because the Medicare IPPE and Annual Wellness Exam components are not met.

I may be thinking way too much, but when I see verbiage as [presents for] "preventive health care"; "patient here for check-up"; presents for "physical examination" my first thought is to be wary on changing the CPT code from a preventive to a problem-driven E&M code.

The documentation has minor problems notated in the A&P, all established problems. To me, these established problems, would not warrant a problem-driven E&M code, as I feel they are minor components and would be bundled with the preventive exam codes.

I’m stuck here. Does anyone have any suggestions on this? We are working to educate the providers and staff, which is a positive step! But I don’t feel these visits should be changed. Is there any acceptable reasons that the visit can be changed from a preventive code to a problem-driven CPT code?

Thanks,
Beth