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meganpoelzer

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A patient had an appointment with one of our internists just to "get aquainted", no issues and no routine exam performed. Vitals taken, hx taken, and ros documented. Would anyone have a clue on how to code this correctly, either cpt or icd-9 code?
Megan, CPC
 
If a PE wasn't performed, I (personally) would go with the 1st one.

"Get-acquainted" visits

Q Is there a code for a "get-acquainted" visit with a new patient?

A No. These services would not be considered medically necessary or preventive and should not be billed to the insurance. Unless your policy is to provide these visits at no charge, patients should be informed when they call to schedule this type of visit that insurance will not cover it and that payment will be expected at the time of service.

http://www.aafp.org/fpm/20060700/coding.html


"Get acquainted" visits

Q: When a patient comes for a "get established" visit with no serious complaints we are coding as an annual exam. Are there separate procedure charges for the breast exam, prostate exam, etc.? Or are these global in the E&M code? If so, should modifier -25 be used anywhere?

A: There is no CPT code for a "get acquainted" visit, so you'll need to perform a true well-male or well-female check in order to bill for these. If you are, the likelihood is that all of the services (e.g., DRE) are indeed included in the E&M. That would exclude lab services, which you would bill for separately, but don't need a modifier. Modifier -25 is limited to noting a "separately identifiable" E&M service - which is used when you have a separate diagnosis; therefore, you need to point out that you've actually performed two services during one encounter (because the patient has two distinct needs).

http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/396/page/3.htm
 
Thanks for your help on this! I agree with the first one but where would we start to determine how much to charge the patient? What if the patient was not informed before the appointment, should they still be liable?

I definitely don't think we should be giving these services out for free but I also know there's nothing in CPT that would be appropriate since no exam was performed and no problems were addressed.

Thanks,
Megan, CPC
 
Is it possible for you to use the unlisted code 99499? As for the fee, maybe you could perform a geographical comparison and base it on the average. I work for specialist and there is a list of questions we ask our patient's prior to scheduling the appointment. I know that Internal Med/Family practice (which I have too) work a little differently but the same type of quality still needs to be provided. The front office can be your best line of defense if they are pro-active.

Just my two cents.
 
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