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10) What is the difference between a Physical and an Office Visit?

A physical – also known as a complete physical or preventive medical exam – is a thorough review of your general well-being.  The clinician will review your known medical problems, perform a complete physical examination and make recommendations concerning your health.  This may include general recommendations regarding diet and exercise, age appropriate immunizations and cancer screening exams such as a pap test, prostate exam or breast exam, and screening lab work.  Ongoing chronic medical problems can be addressed as long as the condition is stable and does not require a change in treatment or additional tests.  Prescriptions, including refills, are generally not included as part of the physical exam.

An office visit is an appointment to discuss new or existing problems.  The questions and exam will focus on the problems discussed.  This may include prescribing medications (including refills), ordering additional tests like lab or x-ray, in-office procedures such as an EKG, referrals to specialists, or discussing other treatment options.

Occasionally, you may be seen for both a physical AND an office visit on the same day.  This means the encounter satisfies the requirements for both types of visits during one appointment.  For example, if you schedule a physical but also discuss an additional problem that requires evaluation and treatment – either for a significant new symptom or a notable change in an existing condition requiring a new treatment plan.  In this situation, you would be billed for both a physical and an office visit during the same appointment, which could include an additional co-pay.

Please note that our billing department bills exactly what your clinician has reported for your visit.  The billing department cannot change the codes before reporting them to your insurance company.  They must reflect the services you received during your visit.  Your insurance company determines what is and is not covered by your policy.  Please call them if you have any questions about your coverage.

We hope this information is helpful.  We want to provide you with the highest quality medical care possible.  If you have any questions or have a concern about what today’s visit will be billed as, please discuss it with your clinician at the beginning of today’s visit.

© 2011 Clinton County Medical Center