Wiki New Patient Office E/M visit Question...

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kaylawilliams66

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Citrus Heights, CA
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We had a patient that was coming in for a new patient endocrinology consultation. This was going to be a 99205 CPT code. It was found that after bringing the patient back to the exam room that she had very high blood pressure. The doctor came in and went over with her that due to her high blood pressure and her extremely high LDL lab results and her age she needed to go to an urgent care or ER. The doctor spent quite a bit of time with her convincing her to go to urgent care. The patient will be coming back for her endocrinology consultation. How would I bill this first aborted visit?
It is an office visit.
Would I still bill for a new patient E/M code and when she comes back to have the actual appointment it would be a follow up E/M?
My concern with billing a new patient E/M code is that all that was done at this first aborted appointment was taking vitals, reviewing lab results, reviewing the referral and other doctors' reports, and the doctor convincing the patient to go to urgent care. But I do not know how else to code it.
 
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Why wouldn't you bill it at all? Time and resources were consumed. It could possibly code as a 99205 since you have a chronic problem w/ severe exacerbation and the high risk of treatment for the very high BP or the number of outside records and tests reviewed may also qualify it as a level 5 visit.. If you coded it by time, since there was so much doctor time, would it qualify for a 99205 w/ prolonged service time?
If the doctor saw her she had an "actual appointment" so I'm not quite sure why there is any hesitation to bill this visit appropriately.

Tom Cheezum, OD, CPC, COPC
 
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Seconding Dr. Cheezum's answer. Bill each visit for the services provided. You may have expected to have the first visit be counseling for diabetes, or a thyroid issue and instead it turned into a hypertension centered visit. But you still rendered medical services to a complex patient and should be paid for such. You should bill new patient based on MDM or total clinician time (whichever works in your favor). For the return visit, established patient also based on MDM or total clinician time.
 
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