A Guide to Your Annual Physical Exam

I admit I’m increasingly frustrated with people who vilify physicians out of ignorance and misinformation. Case in point. A fictional patient with hypertension has a health insurance program that allows for a “free” annual physical exam. You know, one without a co-pay or deductible cost to the patient. He makes an appointment, sees his physician, and a history and physical examination is done. During the course of the visit the patient remembers there’s something he has meant to ask for a few weeks and it is revealed that he’s been urinating a lot (polyuria). The physician is worried for a new diagnosis of diabetes and orders a  number of tests to work up that suspicion. The patient goes home satisfied with a follow-up visit in two weeks. Weeks later he receives a bill for what he thought was a free annual visit. Understandably, or so we think, he is upset. Naturally, of course, he’s angry at his physician for being a greedy pig. Of course. He had a “free” annual examination and he had a right to get a full physical examination and offload all his problems, right?

Incorrect.

What most people don’t understand is that the “free” annual examination, has a code and a description that spells out specifically what falls under that code. Oh, by the way, the way a physician bills for services provided is by looking up codes that match up in a gargantuan book of ICD codes (electronic now) but that’s a whole other story and one that I briefly explored before. There’s a code for annual examination and that is v70.0. You cannot mix codes up. You cannot bait-and-switch. You cannot over-code. You cannot under-code. Whether by honest mistake, by laziness to look up the proper code, or by ignorance of the rules, doing any of the above is committing insurance fraud and can lead to lose of a medical license.

So when you dear patient, decide to use your free wellness examination (v70.0) to discuss your polyuria (788.42) or your non-healing skin ulcer (707.9) or any myriad of ailments, the physician is obligated by your insurance company and by law to separate out the two. The physician can do this two ways. One, tell you that your appointment is for a wellness visit. It will include your chronic condition of hypertension (401.9) but you can make a second appointment to discuss your new medical problems. For most patients that won’t go over well. Most will think their physician is trying to scam them. The second option is for the physician to take a few extra minutes then and there to discuss your new medical problem and bill you/your insurance company for the two visits – a wellness one for your annual and hypertension and a problem focused one for your polyuria.

It’s a bunch of nonsense, yes, in the practicality of things, but guess what? Physicians didn’t create the system – at least not directly. Fact of the matter is that health insurance companies and even Medicare/Medicaid don’t really want to pay for services provided. It hurts their profits or drains their coffers or both. Thus they create all these arbitrary stumbling blocks and make sure to change the rules every few years. Physicians have to play by these rules, and so should you the patient. Just to be clear, it’s not easy to stay abreast of  these ever-changing rules and it’s even more of a struggle because in training physicians tend to be shielded away from the politics and business end of medicine.

Thus, your anger towards us is misguided and not appreciated. If you want to visit your physician once a year because you have better things to do with your time and come with a list of ailments you’ve racked up, don’t expect to use your “free” 15 minute exam to accomplish getting all of them addressed. Free is not more.  Ain’t gonna happen!