Are “Get-acquainted” Visits Billable?

Let medical necessity point you to the correct answer.

A few years ago, I presented to a family practice office as a new patient for a preventive medicine visit. I filled out all the necessary new patient forms, gave the receptionist my insurance card, and was promptly asked for a co-pay. I explained that my insurance policy covered an annual preventive medicine visit at 100 percent, with no co-pay required. The polite receptionist told me it was office policy to perform a “get-acquainted” visit first, to determine my medical history, and that I could schedule a preventive visit for another day.
My initial reaction was to sigh and sit down. But, after thinking about it, for a few minutes, I returned to the receptionist and explained that preventive medicine visits include two categories: new patient and established patient. The new patient category allows healthcare providers to obtain a history and perform an examination relevant to a new patient. As a certified coder and auditor, I tried to be as kind as possible while educating the staff that it was neither appropriate nor necessary to demand that a new patient submit to a get-acquainted visit. I also offered to explain this to the provider.
As you might have guessed, I received my new patient preventive medicine visit from a very nice physician, that same day. And, hopefully, everyone in the office learned something, too.

Educate Providers and Staff

Providers must remember that CPT® codes 99201–99205 are problem oriented in nature, and should be reported only when the services rendered uphold evaluation and management (E/M) of a condition, problem, or symptom of a new patient. Each level of service has specific requirements for the history, examination, and medical decision-making, based on the chief complaint.
CPT® codes 99381–99387, by contrast, are preventive in nature, and should be reported only when the rendered services uphold preventive evaluation, largely based on the age and gender of the patient. Both the problem-oriented and preventive medicine E/M codes allow the clinician a sufficient degree of history to get acquainted with the patient, and to establish a doctor-patient relationship.
There is no CPT® code for merely getting acquainted with a patient. A visit performed solely for taking a patient’s history is neither medically necessary, nor appropriate to report to insurance using CPT® 99201–99205. It’s not appropriate to bill the patient for this type of visit, or to require this type of visit when the patient has no complaints.
Cristy Donaldson, CPC, CPB, CPMA, is a coding manager with University Physicians’ Association in Knoxville, Tenn. She has over 20 years of experience in the healthcare industry. Donaldson previously worked as a coding and compliance specialist in Florida and is now at the UPA Central Billing Office in Knoxville, where she educates fellow team members and supervises appeals. She is a member of the Knoxville, Tenn., local chapter.

Evaluation and Management – CEMC

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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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