established care/transfer of care

[jbhuju]

can established care/transfer of care be coded as preventive visit code? i am kind of new in coding and one of our provider use preventive visit code all the time for established care/transfer of care patient .
thank you

 

[thomas7331]

The terms 'establish care' or 'transfer of care' and very vague and problematic terms that don't really tell you how a visit should be coded. I've always advised providers to avoid using these terms in medical records as reasons for a visit because they create confusion and do not support medical necessity for a service.

There is no CPT code for a visit simply to 'establish care'. To know how to code a visit, you'll need to look at what is actually happening at the encounter. In the case of a transfer of care, the provider may be taking over the management of ongoing chronic problems that require doing a history and/or exam and in which case a problem-related E/M visit code will be appropriate. On the other hand, if the patient does not have any current complaints or chronic conditions that require the provider's attention, and the patient is due for their routine physical, then it may be appropriate to code the encounter as a preventive visit, assuming the documentation supports it. It becomes a little more problematic when the visit appears to be nothing more than a well patient who is simply coming in to the office to meet the provider and hand over their records from the previous practice for future use. In that case, there's no real need to be performing an evaluation of the patient and/or billing for an encounter, so that may be something you need to discuss with the providers to get clarification for how you should code and bill, if at all.

Hope this helps some.

 

[jbhuju]

thank you so much for clarification