Wiki New patient documentation

[queeniek]

Scenario:

Outpatient setting, provider fails to document all 3 key components, but has documented 2/3 key components.
Can an established patient visit be billed, or should we bill nothing at all?

Thank you.

 

[Chelle-Lynn]

The rule of thumb "code for what you did - not just to get paid" would apply. If the patient was a new patient but you are unable to level the claim because only 2 of the 3 components were met then it would not be appropriate to bill for an established patient as the patient is new. This would warrant a possible query back to the provider to ensure that all documentation was provided. If so, it would be a good training opportunity to explain the 3 of 3 rule with your provider for next time.

 

[TPeniston61]

It is my understanding that if you can only meet 2 out of 3 of the criteria for a level 3 new patient visit, you would bill the level below it.

 

[twizzle]

It is my understanding that if you can only meet 2 out of 3 of the criteria for a level 3 new patient visit, you would bill the level below it.

I'm interested to know where that information came from. How would you bill the level below when you don't have a level? The requirement is that 3/3 components need to be documented to assign a new patient E/M level.