February 10, 2016

When A Preventive Health Visit Changes to "Diagnostic"

Sandy Miller, Indiana State Medical Association - Photo provided by ISMA

Sandy Miller, Indiana State Medical Association

Photo provided by ISMA

INDIANAPOLIS -- Like a lot of people, if you know your “preventive” physical is coming up, you might wait until then to bring up recent health concerns, instead of scheduling a separate appointment with your doctor.

Sandy Miller, director of practice management for the Indiana State Medical Association, says during a preventive examination, doctors are required to note a new diagnosis and change the coding for the appointment from preventive to diagnostic.

“In the middle of the exam, if there is an issue, his documentation obviously has to support that," she explained. "He would have to write down, I found this, I found that."

And based on that documentation, the doctor is regulated by law to change the coding over to diagnostic, "because he’s preparing to give you a new diagnosis. He’s preparing a brand new treatment plan,” Miller said.

Preventive care only covers specific things, so a new diagnosis means you’ll likely be getting a bill in the mail – something you might not be expecting. Miller says in any case, you have a right to see documentation on your medical record.

“These are conversations that the billing office is accustomed to having," she said. "You would certainly have a right to contact the billing office or the practice manager or the billing manager to determine exactly what elements of your visit rose to that extra code. And they should be able to provide that for you.”



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