New patient preventive visit and problem-oriented visit

PennyG

Networker
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80
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During the course of a new patient preventive visit, a problem/abnormality is found that is significant enough to warrant additional workup to add a problem-oriented e/m service. Which will be classified as the new patient visit? The preventive or the problem-oriented e/m service code?
 

Lynda Wetter

True Blue
Local Chapter Officer
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515
Location
Richmond Virginia
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Good morning.
This very same question was brought to me recently.
The best answer here is...since there is no guidance is to bill/code how you see fit. The payer will basically tell you how they want it. (chances are they will deny any way you send it) But you should see what they say and set an internal process/guideline on how to handle future cases such as this.
In my opinion the preventive visit would be new and the problem visit would be established. My thinking is a payer only wants 1 new patient visit within a 3 year period and most of their systems will most likely kick it out.
 
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