Wiki New Patient E/M PFSH

[LAKEENYA]

Hello,

Anyone's help will be highly appreciated. Can someone tell me if it is a requirement to have a complete PFSH when billing a new patient charge? I have been told that it is not a requirement. I have read the 95 coding guidelines and I understand you are required to have all 3 to have a complete history but do you need a complete history for a new patient code? If you only had one pertinent component of the PFSH, can you still bill a new patient E/M? Again any and all responses is appreciated. Thanks

 

[leebennie]

You have to have a complete PFSH in order to qualify for the highest new patient E/M codes, 99204/99205. If you have 1/3 PFSH on a new patient, you could qualify for a 99203. Lower new patient E/Ms 99201/99202 don't require this.

 

[teresabug]

Clarification on the above answer- this is directly from CMS 1997 documentation guidlelines:
"At least one specific item from EACHof the history areas must be documented for the following categories of E/M
services:
❖ Office or other outpatient services, new patient;
❖ Hospital observation services;
❖ Hospital inpatient services, initial care;
❖ Comprehensive NF assessments;
❖ Domiciliary care, new patient; and
❖ Home care, new patient

 

[rthames052006]

Hello,

Anyone's help will be highly appreciated. Can someone tell me if it is a requirement to have a complete PFSH when billing a new patient charge? I have been told that it is not a requirement. I have read the 95 coding guidelines and I understand you are required to have all 3 to have a complete history but do you need a complete history for a new patient code? If you only had one pertinent component of the PFSH, can you still bill a new patient E/M? Again any and all responses is appreciated. Thanks

Yes, all 3 PFSH areas are required for a complete PFSH of a new pt visit. If the provider doesn't have all three documented ( but at least 1 of them) the selection the PFSH area will be "pertinent" and the history area will become detailed, rather than a comprehensive history.

 

[garciablanca89]

Help??

question about the PFSH when it documents " (PFSH) has been noted and reviewed” does that count as done?

 

[jvanek82]

question about the PFSH when it documents " (PFSH) has been noted and reviewed” does that count as done?

No. In order to count any part of the PFSH the provider would have to document something for each element. Such as: Personal history - patient has Diabetes; Social history - patient is non-smoker, lives with family; Family - no family history of lung cancer. It is also no appropriate to say non-contributory or none known, etc. as these statements imply the physician did not ask the patient about any of this information.