|Q:||A specialist’s consultation report came back three weeks after our patient had a face-to-face visit with the PCP, and revealed some new risk adjusted diagnoses. Can my PCP make an addendum and report them?|
Probably not. An addendum is used when the patient was assessed for a condition during the visit and the PCP needed some additional information, to be received very timely, in order to make a definite diagnosis. Addenda are not used to add new information or information that was ‘forgotten’ during the visit. The face-to-face visit must explicitly state what the PCP assessed, what she suspects and why, and where she is sending the patient for additional work-up.
If the information she needs is received timely (and there is no definite number of days, but it’s usually within a week, at the most), the PCP can make an addendum to the visit.
In the case explained above, we recommend that you schedule a new appointment with the patient so the physician can assess/document the conditions. You can then code them and submit to the health plan.