I am very interested in learning about providers billing a patient as new and established at the same time.
I work in the medical field. I came across a claim where the provider billed three lines of service. A 99386 New Patient - For the preventative visit - dx - Well GYN exam. On the next line they billed the Q code which is ok, and let me add, they also attached a 25 modifier to the 99386. On the 3rd line they billed a 99213 - Established Patient - Office or other outpatient viist, attached a modifier 25 to this code as well.
Can a provider's office bill this way - any provider seeing a patient for any type of visit?
Can they bill a new and a established patient E/M on the same claim?
The insurance company paid all 3 lines. They covered the preventative at the full allowance and then paid for the office vist @ 50%. Is this right? It does not seems to make since that the provider would bill both at the same time. The CPT and CMS guildeliness appear to agree that in "history" a patient is consider established once there as been a face to face.
Last thing, both E/M codes were attached to the same diagnosis code. The Well GYN Exam.
Thank you so much.. any help would be appreciated.
TiffanyM.
I work in the medical field. I came across a claim where the provider billed three lines of service. A 99386 New Patient - For the preventative visit - dx - Well GYN exam. On the next line they billed the Q code which is ok, and let me add, they also attached a 25 modifier to the 99386. On the 3rd line they billed a 99213 - Established Patient - Office or other outpatient viist, attached a modifier 25 to this code as well.
Can a provider's office bill this way - any provider seeing a patient for any type of visit?
Can they bill a new and a established patient E/M on the same claim?
The insurance company paid all 3 lines. They covered the preventative at the full allowance and then paid for the office vist @ 50%. Is this right? It does not seems to make since that the provider would bill both at the same time. The CPT and CMS guildeliness appear to agree that in "history" a patient is consider established once there as been a face to face.
Last thing, both E/M codes were attached to the same diagnosis code. The Well GYN Exam.
Thank you so much.. any help would be appreciated.
TiffanyM.