Wiki How does your practice bill new patient visits?

[AngelaFS1091]

Our practices bill new patient visits as an office visit (99202-99205) then have patients come in for physicals at a later date, however, we do have the occasional patient who is upset by this and feels it should be coded as a new patient physical (99385-99387). What does your practice do?

 

[Pam Warren]

Ah.....these patients figured out that physicals incur no deductible or co-insurance.

It depends......why do these new patients want to see you? Do they simply need to establish care and have no problems that need to be addressed? If so, bring them in for a new patient physical. If problems crop up during that visit, offer to re-schedule another visit later because today's visit slot is only time enough for the Pe. You do have the option to add on an E&M at the same time if documentation allows (and let them know there's going to be some financial impact), but that annoys patients as well. If when they call initially, they have a problem that they want the provider to address, then schedule an office visit and let them know that your provider can't perform a preventive physical exam if they already have a condition that requires evaluation and treatment. Create a 'script' that your front desk reps can read off to help new patients understand the service that's going to be rendered, why, and how it's likely to be covered by their insurance. Tell them that you are legally obligated to bill according to what you performed. If it ticks off a patient so much that they won't schedule an appointment, consider yourself lucky.
Healthcare is a business, but it's one of the most highly regulated industries in the United States. Federal rules indicate what can/can't be done and there is an ethical expectation as well for licensed professionals. Don't let patients force you into providing services that fall outside of compliance.