Quote:
Originally Posted by biker1
I have seen the term "long visit" on EOBs from visits to The Villages Health before (pre Medicare age).
I also had a Medicare insurance question about two years. I had several conversations with my PCPs billing folks, my Supplemental Plan, and Medicare itself. The question was "why did an annual visit (to essentially go over blood work) count towards my Part B deductible and carry a $20 copay? I was under the impression that these "wellness visits" were covered 100%." The only person who was able to answer the question was my PCP. What she told me I found interesting. She stated "if you come in for an annual visit and don't have any issues to discuss then it would be coded as a "wellness" visit and would be covered 100% without impacting my Part B deductible and being charged a copay. If I discuss any issues bothering me (i.e. my knee is getting worse) then it gets coded differently and would count towards my Part B deductible and might have a copay (I have Plan N)". Who knew ...
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"I have seen the term "long visit" on EOBs from visits to The Villages Health before (pre Medicare age)."
If it was there, it was not an official CPT term or criteria----I've already posted those criteria and there is not term "long"
As for the rest of it, it is even more complicated than the answer that was given.
If your appointment was scheduled as the annual wellness visit:
If you then bring up another problem, the proper procedure is for the physician to complete the wellness visit, close the note and start a new note on the problem. The she is supposed to bill for both with the appropriate CPT codes and the "problem" visit may be subject to a copay.
If it was booked as a visit for a specific problem:
And the physician states "while you're here let's also do your annual wellness visit", that is a violation of the rules and would subject her to paying the wellness visit back
Kind of dumb, predicating two different billings on the original reason for scheduling the visit, but those are the dumb rules