Wiki Level 1 E/M for New Patient same DOS as minor surgical procedure.

[arozance27]

A provider states that a 99201 is always billable for a new patient when presenting for a minor surgical procedure to account for the extra work performed because they are new to the practice. I believe based on CMS info, that unless there is a separate problem unrelated to the surgical procedure, a separate 99201 is not supported. Am I missing anything regarding work performed for new patients?

 

[CatchTheWind]

The provider is wrong. There has to be a "significant and separately identifiable" E/M service in order to bill, even for a new patient. (Sorry that I don't have the source at hand, but I know I've seen this in CMS documents.)

 

[CodingKing]

NCCI Manual states:

If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. (Osteopathic manipulative therapy and chiropractic manipulative therapy have global periods of 000.) In general E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure.