Wiki New Patient Billing - patient codes

[Salemcoder]

We are receiving denials from one payer for New patient codes (99203,4,5) because a stress test was billed prior to the new patient eval. My understanding is that is not considered a "professional" service. But since there is a physician supervising the test -- would you consider it professional time? I would like to appeal these, but need some supporting documentation. Any ideas?

 

[dclark7]

A professional service is defined as any face to face service and reported by a specific CPT code. If your physician is supervising a stress test (93015) he is reporting a code that is considered providing a face to face service. If all he did was interpret the stress test and reported that with code 93018 then it would not be considered a face to face service. If the new patient visit is being done on the same day as the stress test you could add modifier 25 to the E/M as long as the documentation supported it.

Hope this is helpful.