Wiki E/M with Medicaid Billing- Iowa


Adel, IA
Best answers
I've got a question that I'm not sure of the answer to explain to my physician. It's Medicaid billing in Iowa. My physician sees a new patient for an evaluation for a Cesarean delivery only along with a tubal for sterilization. Her initial office visit was billed out on 01/17. Her Cesarean delivery and tubal were done on 02/01. Are all initial office visits for a new patient not covered under title 19? He did a full H&P so it was coded as 99203 (01/17) and 59514 & 58611 (02/01). My physician is upset that he can't charge for seeing new patients when determining the need for surgery. Any advice?

Thank you!
You can bill only 99203 on 01/17 as only emservice was performed as a new patient
and you can bill 59514 and 58611 and 99212 on 02/01
I billed 99203 for new patient on 01/17. I billed the surgery out on 02/01 as 59514 and 58611. I didn't bill for an office visit on 02/17 as it wasn't a service that was provided. But Medicaid still denied my new patient visit on 01/17 as included with the surgery procedure on 02/01. It's my understanding that the surgical global period is the day prior to a surgery and through the 90 day global period plus the post op visits. That's why I'm questioning Medicaid and why they consider that first initial new patient visit included... ?