Wiki New Patient Visit Question

[jenmendoza]

Hello, everyone! I have a quick question regarding E/M and the changes in 2023.
So I have a patient who was referred to Dermatology for condyloma, and was deemed by the doctor for just skin tag removal. Nothing of note seemed to have been discussed based on the clinical note so the provider coded it as a non-LOS visit and just put the CPT code for the procedure in.

My question is, since the patient is new, is this appropriate, or is there supposed to be an E/M always included for new patient visits for specialty clinics?

TYIA for your answers!

 

[thomas7331]

There’s nothing wrong with this, and there’s no requirement that a new patient E&M be billed at a patient’s first visit. The patient becomes established just by the performance of the procedure alone. In fact, if the documentation does not support a modifier 25, it would be inappropriate to bill a new patient visit with the procedure.

 

[jenmendoza]

There’s nothing wrong with this, and there’s no requirement that a new patient E&M be billed at a patient’s first visit. The patient becomes established just by the performance of the procedure alone. In fact, if the documentation does not support a modifier 25, it would be inappropriate to bill a new patient visit with the procedure.

Thank you so much for this, this has been very helpful!

 

[heatherposchman1]

Per NCCI edits, the new patient codes 99202-99205, do not bundle with the skin tag removal codes, and both are able to be reported without modifier 25. It is correct, though, when the patient is established, they do bundle and modifier 25 would need to be supported to report both the E&M and procedure codes.