Types of Appointments
Office visits, otherwise known as focused visits, are best suited for 1-3 topics you want to discuss. Depending on the complexity of the concerns, all three topics can be taken care in one visit. However, sometimes to ensure the highest quality of care we request you come back for a follow-up visit to ensure there is enough time to address your needs.
This is the most common appointment type and is divided into levels 1 through 5 (each with its own Current Procedural Terminology (CPT) code) based on counseling time, medical risk, and decision-making criteria that are very complex. Most clinics use professional coders and/or software to help generate CPT codes for an office visit, which defends the clinic against any claim that it applies charges to different types of patients differently. Believe it or not, “down-coding” an appointment in order to charge a patient less than the calculated office visit level is penalized the same as “up-coding” in order to charge a patient more than the calculated office visit level! The legal word that describes this is “malfeasance” by unfairly favoring some patients over others. Most office visits trigger the CPT code for one of levels 3 through 5, since level 1 can’t even involve the doc and level 2 gets surpassed readily in visits of any substance.
During this visit type, we review your past medical history, family medical history, health habits, current medications, and allergies. We perform a screening physical exam. We synthesize the information into a personalized assessment of disease risk. We recommend for or against additional screening tests to screen for common cancers, and screening tests to help clarify your risk status for heart attack or stroke. We discuss the impact that lifestyle can have on your particular health future.
What is not included in a preventative screening physical? By CPT coding rules, the preventative screening physical cannot include “active management” of a medical problem or symptom unless a separate “office visit” is also coded alongside the screening physical – which will transform the appointment type into a combined visit (described below). Medication refills and dose changes can be included in the preventative screening physical, but new medications, treatment strategies, and referrals (other than screening referrals) trigger CPT codes for “office visit”.
These distinctions are important because some insurance companies waive all out-of-pocket costs for one preventative screening physical appointment per year (i.e., no copay,no co-insurance, no deductible payment). Be sure to ask your insurer if they are one such company. When you schedule a preventative screening physical – with Wise Patient or any other clinic – you should emphasize to the clinic that you are scheduling a preventative screening physical. That way we can do our part to insure the contents of the visit do not include things that would trigger an “office visit” code to be generated and billed out.
Some insurance companies do not cover travel-related appointments. In light of this shortfall, we offer a $50 self pay appointment with one of our medical assistants (no face-to-face time with the MD) who will go over the recommendations for your particular itinerary and have any prescriptions approved by one of our physicians. A physician will review the medical assistant’s recommendations and confirm they are indicated, but will not see you directly. We feel our $50 self pay price is competitive with many of the local pharmacy prices that we have seen.
If your insurance plan does cover pre-travel visits we are happy to send the claim to your insurance company at your request, just let us know!
Blood Draw
Our Health Coaches are all certified phlebotomist. If blood work is indicated at your appointment we draw your blood right then and there. However, some tests require you be fasting so we allow patients to book blood-draw only appointments every morning at 8am. We do not offer blood draw appointments for patients who have not seen one of our physicians prior.
Please be aware that any blood tests we think are in your best interest will be sent off to an external facility (Lab Corp or Quest Diagnostics) for the test and the lab will bill your insurance accordingly. We have no control over the prices of those labs as the amount it will cost you depends on your insurance plan.
If you are a Direct Primary Care subscription patient, we offer self pay prices at a fraction of the cost that most insurance companies will charge you.
Vaccinations
We supply the influenza vaccine during the recommended time to get vaccinated (September-April). In addition, we supply the TDAP vaccine (Tetanus, Diphtheria, and Pertussis) and are happy to administer it when indicated. As a small clinic, we do not have the necessary volume to stock any other vaccines and therefore any vaccines you may need can be sent to you local pharmacy for administration.