Patient seen every 4 months. Chief complaint exactly the same every time ; dual chamber pacemaker implant due to complete av block, 2003, Hypertension, Hyperlipidemia and Hypothyroidism.
HPI: also the same copied and pasted from original history of pacemaker implant and continues as HPI with minor tweaks; Patient presented with chest pain and nausea, september 2003, diagnosed with AV block, dual chamber implanted, asymptomatic since implant. No current complaints except toe pain. Pacemaker interrogated today and shows: _____ blah blah blah___
ROS: negative except for HPI
Exam: We’ll say comprehensive for the sake of brevity. + toe pain
Impression:
Pacemaker function normal
Complete AV Block, asymptomatic
Hypertension
Hyperlipidemia
Hypothyroidism

Can a patient’s history of pacemaker implant and historical and/or maintenance conditions that are stable or asymptomatic, be carried over every visit to qualify as an E/M? Wouldn’t there have to be a chief complaint? These seem like periodic scheduled pacemaker interrogations that are being upcoded with an E/M visit. Billed as 99214 with 93280, every 4 -6 months. This provider is somewhat hostile. How do I tell him without accusing him that this E/M is not warranted, or is it? I try explaining medical necessity, I try explaining components of E/M, I’m written lengthy essays on how complicated this case was etc.., Makes me very uncomfortable to submit these claims. Had one today whereby patient was experiencing a noisy lead on PM, no other complaints, saw the patient 2 weeks prior for the same reason, both visits billed as 99215 with 93280.