Wiki Establishing Care without complaints

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SUEV

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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 think it meets the requirement to bill the Initial Comprehensive Preventive Medicine codes. Does anyone bill for these type of visits? If so, do you bill the pt or the insurance? My concern is that there isn't any medical necessity to the visit if you don't do enough to even bill for codes 99381-99387. Thanks for any opinions on the matter!
 
I re-read your note, and I am confused. If this an initial visit or an established pt. Why would the patient be coming into your facility without a reason. You are right about the medical necessity. You must have a chief complaint. If this is a follow-up visit, you can construde that to be the cheif complaint, but it doesn't sound like you have a billable visit.
 
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"Get to know you" visits

These are "getting to know you" visits ... typically someone has moved to your area and needs to get established with a new primary care physician. No complaint, no issues, just needs to get established.

There are three possible ways to go here.

Option 1 - consider it a cost of doing business, and good customer service. Don't bill anything. Perhaps use a dummy code for tracking purposes.

Option 2 - Use the Unlisted E/M 99499 and bill at a relatively low cost.

Option 3 - Bill the patient directly for a non-medically necessary visit.

I like Option 1 myself. That means that when the patient actually presents for a full physical or sick visit you will be using a new patient code vs established patient.

NOTE - I am talking about a visit with NO exam, NO Rx, NO complaint. At most you might have a history form filled out and a form to request copies of records from the previous physician.

Whatever your practice decides, put your policy in writing and treat ALL such patients the same way.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
SUEV said:
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 think it meets the requirement to bill the Initial Comprehensive Preventive Medicine codes. Does anyone bill for these type of visits? If so, do you bill the pt or the insurance? My concern is that there isn't any medical necessity to the visit if you don't do enough to even bill for codes 99381-99387. Thanks for any opinions on the matter!
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In our practice these visits are treated as preventive. Of course, the provider performs the necessary exam, so that's different than your scenario. The medical necessity is that the provider needs to get to know the patient too.
 
Thanks

We've said in the past that these "meet & greets" are done more as a courtesy so aren't billable but sometimes they sneak thru from the provider. Thanks for your suggestions!
Sue
 
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