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Ophthalmology and Optometry Coding Alert

E/M:

New or Established? Answer Wrong and It Could Cost You

Published on Wed Sep 01, 2010

Remember, what used to be a consultation is now likely a 99201-99215 service. Your ophthalmologist provides a new patient with a standard office-visit E/M. You use an established patient E/M to code the encounter. No big deal, right? Wrong: Not only is the coding incorrect, but this mistake will cost your practice deserved reimbursement. Further, Medicare's non-payment of consultation codes means that coders will have to answer the new vs. established question more often than before. For Medicare and payers that follow their lead, coders will now have to "select the correct code, new or established, to bill for what used to be consults and did not have a new versus established component concept," relays Quinten A. Buechner, M.S., M.Div., AAPC:CPC, BMSC:ACS-FP/GI/PEDS, ACMCS:PCS, PHIA:CCP, PAHCS:CMSCS, president of ProActive Consultants in Cumberland, Wis. Nail the patient's status every time by following this expert advice on new and established patients. Leave Money on [...]
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