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how to bill the scenario

J

jbhuju

Guru
Messages
168
Location
Prosper, TX
pt had preventive visit, office visit and vaccine
example
99386
99213
90715
90471
do i add modifier 25 on both 99386 and 99213 ?
 
Yes, you'll need to do the following in order to get all paid. Keep in mind that some payors don't want to pay the separate E/M but I typically send back to them that both encounters are supported and correct per documentation. Have you been advised by your team to code a new patient CPE and an est. patient E/M? The guidelines says to code both as new patient. Some facilities don't practice this, so talk to your superior about what their guidance would be.

Can we bill a new patient visit for preventive and E/M services on the same day?

A physician sees a patient for a preventive medicine service and addresses an acute, significant problem. The patient is new to the provider.
codingintel.com codingintel.com

99213-25
99386-25
90715
90471
 
OpenClaims said:
Yes, you'll need to do the following in order to get all paid. Keep in mind that some payors don't want to pay the separate E/M but I typically send back to them that both encounters are supported and correct per documentation. Have you been advised by your team to code a new patient CPE and an est. patient E/M? The guidelines says to code both as new patient. Some facilities don't practice this, so talk to your superior about what their guidance would be.

Can we bill a new patient visit for preventive and E/M services on the same day?

A physician sees a patient for a preventive medicine service and addresses an acute, significant problem. The patient is new to the provider.
codingintel.com codingintel.com

99213-25
99386-25
90715
90471
Click to expand...
thank you so much for the clarification :) and yes bot cpt are new 99203 i am sorry i did 99213 on my question :)
 
ndelaigle@duncanorthopedics.com said:
Scenario... Doctor seen patient at Orthopedic Clinic 1 in 2023 for Right Knee Pain. Doctor now has a new practice with a different NPI number and saw the same patient in 2025 for Right Knee Pain. Can we bill a 99203
Click to expand...
No. It is established to the provider (as a person) not where they practiced. Same patient, same provider within 3 years=established.
 
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