Our Goal at the Canandaigua Medical Group is to provide Quality patient care for all ages. As healthcare and insurance rules and regulations continue to change, we want to help educate our patients on the how we bill for services provided. These services are defined by the government services programs and commercial health insurers with whom we participate.
What is a Physical Exam?
A Physical exam is a preventive medicine exam designed to evaluate the general health of the patient. It is a comprehensive and thorough exam that includes gathering medical history and lifestyle information from the patient and/or parent, an examination of the main organ systems, including obtaining standard vital signs and biometrics, and counseling and/or guidance on risk factor reduction interventions. A physical may also include laboratory and screening tests to evaluate for potential diseases, as well as immunization updates. These tests and immunizations usually have separate medical billing codes in addition to the physical exam billing code.
Please note - diagnosing and/or treating an illness or chronic condition is not part of a physical exam. These items fall under the scope of an office visit or office exam. If these conditions are diagnosed or discussed during a physical exam, we are required to document them separately, and bill for both a physical exam billing code and an office exam billing code. This may impact your copay or deductible depending on the type of insurance you have.
What is a Follow Up exam?
If a medical condition is identified, whether acute or chronic, a follow-up exam is often required. Some examples of these conditions are: hypertension, acne, asthma, high cholesterol, etc. Follow-up visits may take place within 1-2 weeks or as far out as 3 to 12 months. Generally, when patients are taking maintenance medications there will be several follow-up visits throughout the year. The purpose of these visits is to determine that the appropriate course of treatment is in place and the medications are well tolerated and effective. These appointments are billed as office exams and may require a co-pay or impact your deductible.
The Patient is responsible for their insurance
At the Canandaigua Medical Group, we will do our best to work with your insurance company. With the large number of variations in health insurance plans, it is important for the patient to know their insurance policy, including what is and is not covered and what the various levels of copays and/or deductibles are.
