Wiki can you use 2 new pt codes at same visit?

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tosullivan

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Hi! Need help with this senerio...A new patient comes in for a physical and the physician performs an EM at the same visit.
Do you code the physical as new and the EM as established or do you code both as new? Not sure if you can use 2 new patient codes at the same visit.
Anyone know the answer to this one?
thanks Tina
 
Check the forums

There have been several questions about this in the past. Check the E/M and Family Practice forums to be sure.

My opinion, is you code both visits as new patient (one preventive, and one sick visit).

BUT ... in practice this is VERY hard to carve out. You will have to have a complete documentation for the new patient sick visit that is competely separate (and not duplicated) in the preventive visit.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
we do not code two new. How can you be new twice? Your first visit would be new and the second E and M would be return as if the patient left and returned for another visit . You are trying to support two different visit so if in fact the patient left and came back they are not new again
 
2 new visits

I agree. Bill your pe w/new code as that is worth more money and bill the sick visit with an established code. :)
 
Thanks for your input but I did find out last night during a chapter meeting the correct answer is you would code both as new.
Of course documentation must support the additional EM code and in our case it did.
So the correct answer is both the physical and additional EM (mod 25 added) would be coded with new patient codes.
thanks again for your thoughts
Tina
 
That is correct. CPT instructs you to select the appropriate E/M code (99201-99215) for a problem addressed during a preventative exam. There is also a CPT Assistant that supports a new patient E/M along with a new patient preventative.
 
I would code using both the new patient preventative E/M code and the new patient E/M code. Here is my logic....the defintion of a new patient in the CPT manual states being seen by the provider within three years. If the patient presented for a physicial and truly met the defintion of a new patient, then three years did not go by before next E/M service. So both new patient codes should be used.

Just my opinion.
 
Lisa Curtis said:
Perhaps it is a contractual issue with some carriers to pay both new. However, I have never seen Medicare pay two new visits.
Click to expand...

Since this was posted in the "Ped" forum, I assumed we were speaking about a commerical carrier. Additionally, you wouldn't bill MCR for a new wellness and new problem oriented visit since a preventative exam is not a payable benefit (other than the IPPE); which could be payable with a new problem oriented visit.
 
I just wanted to comment on the logic of coding "to get paid" vs "correct coding"
Of course I understand we need to get paid!
But we as coders should not bow down to greedy insurance companies.
It is our responsibility to code correctly! regardless of how insurance companies reimburse!
We need to set the standard, be a united front on correct coding and eventually the insurance companies "should" follow....just my opinion!
Tina
 
tosullivan said:
I just wanted to comment on the logic of coding "to get paid" vs "correct coding"
Of course I understand we need to get paid!
But we as coders should not bow down to greedy insurance companies.
It is our responsibility to code correctly! regardless of how insurance companies reimburse!
We need to set the standard, be a united front on correct coding and eventually the insurance companies "should" follow....just my opinion!
Tina
Click to expand...

Tina - I hope you don't think I am an advocate of "coding to get paid". What I want for my providers is payment for the services that they provide. If that means coding one new and one established E/M as this scenario states, that is what needs to be done. Just because the AMA puts out CPT and guidelines doesn't mean that those guidelines are interpreted the same way by everyone. I agree that we as coders should set the standard and code correctly...the issue is the interpretation of guidelines by multiple individuals vs the insurance companies. In my organization I am not involved in the contract agreements nor is my input requested. The insurance companies set their policies whether we agree with them or not, and if we have a contract we must abide by that contract. I am not suggesting any kind of false coding, I am suggesting that we follow the policies of the contracts we have. That or have no contracts, which would leave us without patients to treat. Just my thoughts.
 
I agree. Just to reiterate...CPT address' a New wellness visit in addition to a new patient, problem oriented visit. CPT's instruction:

If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem or abnormality is significant enough (emphasis mine) to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate office/outpatient code 99201-99215 should also be reported.

This is not an insurance directive but rather CPT.
 
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