New patient comes in to establish with provider

cnramsey

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I have a really hard time with these visits.. Provider wants a 99203. But I can't get 4 elements out of the HPI.. Any advice on how to code these types of visit with be greatly appreciated. Sometimes the HPI will have even less than this particular visit. Thank you
Primary Care Provider: MD
Accompanied by: Self
Visit Type: Follow-up

Patient Agenda: PFT recommend by PCP.
Consider LDCT in 1 year to follow up on 3mm nodule.


Chief Complaint: Establish care

History of Present Illness:
Pt comes to establish. Moved from the west side of the state. Her son moved over here and she moved with her younger son and grandkids here.

Reviewed records

Pt wants to restart on HC again. She hasn't been on them since April or May.
 

atilton

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Warren, MI
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According to Medicare Guidelines Establishing Care is not a medically necessary chief complaint. I train residents in family medicine and I explain to them that 99201-99205 are new patient sick visits. If the patient is not presenting with a medical issue to be evaluated and treated then the provider should really be doing a physical. If the patient is not due for their physical then registration staff should be explaining to the pt that they may have to pay out of pocket for an "establishing care" visit. Meet and Greet with a new doc is not a medically necessary visit to bill to insurance.
 

cnramsey

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Another example:
Patient is transferring her care to us from another facility. Providers HPI has the status of 3 or more chronic problems, complete ROS and PFSH. Exam General, Head, Lungs, Cardio, Abd, Extremity, skin and Psych. A&P Hypothyroidism, Atrial Fib, CHF, HTN, Osteopenia, depression, copd, chronic low back pain all unchanged status no issues, Umbilical Hernia New but all she does is discuss avoiding straining and constipation, precautions given for patient. Meds and problems are added to patients EHR. No refills, no labs and no other tests or referrals. Provider is picking 99204. But wouldn't this support a 99387 since this was not a sick visit?
 

thomas7331

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This would be a sick visit since the new provider (assuming this is primary care) is taking over the management of the chronic problems, as well addressing the new umbilical hernia. Even if these are stable problems, they are still new to the provider and may require an evaluation. In this situation, I advise providers to document, for clarity, something to the effect that the reason for the visit is not simply to transfer or establish care, but is also because the patient needs continuing management of their chronic conditions.
 

cnramsey

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This would be a sick visit since the new provider (assuming this is primary care) is taking over the management of the chronic problems, as well addressing the new umbilical hernia. Even if these are stable problems, they are still new to the provider and may require an evaluation. In this situation, I advise providers to document, for clarity, something to the effect that the reason for the visit is not simply to transfer or establish care, but is also because the patient needs continuing management of their chronic conditions.
Thank you so much for responding to my question. This is being debated between coders. I think this will help a lot. Thanks again! I really like the verbiage( advise providers to document, for clarity, something to the effect that the reason for the visit is not simply to transfer or establish care, but is also because the patient needs continuing management of their chronic conditions.)
 
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