Diagnosis used for new patient to establish care

[baskiles]

Hello all, what diagnosis do you use for a new patient without any issues/concerns is seen specifically to establish care. We're a family practice. Can dx Z76.89 be used or is it acceptable as a primary diagnosis?

 

[csperoni]

I would have to wonder what the medical necessity of this visit is. If the patient has no medical problems or concerns and is not receiving preventive care, then what CPT are you billing to even assign a diagnosis to?

Coding Corner: Physician/patient meet-and-greet

Insurers, including government payors such as Medicare and Medicaid, reimburse only those services or procedures that they deem to be medically necessary—and a meet and greet doesn’t meet the definit...

www.cmadocs.org

 

[csperoni]

Here are some other threads discussing this as well:

Establishing Care Visit

I have a couple Docs that see patients to establish primary care. On some visits, they treat the patients and on some they are only establishing care and do not perform services. On the visit to establish that services are performed, can this be billed as preventative? And on the one that is...

www.aapc.com

Establishing Care without complaints

Hello all, If a patient comes in to establish care, doesn't have any complaints, and only a minimal exam is done, is that a billable visit? Nothing's documented that could be construed as preventive counseling and since the exam was limited to vitals & listening to the lungs & heart, I don't...

www.aapc.com

establish care with no problems

I have had patients come in to establish care with our physician. No physical exam was done, no presenting problems, no meds filled...nothing! Just establishing care! Can I bill for this and if so how? What dx would I use? Thanks in advance!

www.aapc.com

Establishing Care -What dx code should

We are scheduling our new patients for a "meet and greet" appointment to basically establish care. The patient is rescheduled to come back for their physical. What dx code should we use if the patient has no medical issues and/or complaints at the first visit? If we use V70.0 then insurance will...

www.aapc.com

New Patient Dx code advice

In the case where a new patient comes in to establish care in our office (PCP), I have had some denials when the providers use Dx Z76.89 I had a couple denials stating not a covered expense and others stating not covered when considered routine due to the use of the Z code. Say in the case...

www.aapc.com

 

[TThivierge]

Hi Basiles,
I would not use dx Z76...not ever as first listed dx. It depends what done during the visit ...meet and greet only is not worthy of reimbursement. However did patient's vitals get taken meds reviewed, organs checked such as mouth, heart, limbs,Etc. Are they getting a annual physical dx Z00 blocks, or pap Z01.401 or prostate check Z01.89 or need to lose weight see dx blocks of E66, Z68 and Z71? Is their past medical history discussed? Anyway I 'd bill for new patient CPT 99202 for 15 to 20 minutes but it must be documented what done and discussed.
I hope this helps you.
Lady T

 

[rturner96]

Hello all, what diagnosis do you use for a new patient without any issues/concerns is seen specifically to establish care. We're a family practice. Can dx Z76.89 be used or is it acceptable as a primary diagnosis?

If documented correctly, Z00.00 would be appropriate. Insurance plans requiring the patient to list a PCP could be a driving force for the visit. If this is the case, document as the reason for the encounter. If the patient is new to the area and wanted to establish a rapport with a PCP, document this as the reason for the encounter. I assume the patient completed a medical history form. History codes as secondary codes would help support medical necessity. Hopefully an exam was done to establish baseline information. Were medications, if any, documented or is there documentation that the patient is not taking any medications? Is your doc going to take over any medication management? Did the patient provide past medical records for review? It all boils down to what was done and how well it was documented. If they just did a chit chat and a handshake, then your doc worked for free.