Wiki New patient Vs Established

[tammyj0212]

Please help!

If a patient comes in for a consult before a procedure and there are no presenting problems meaning there is no HPI can I downcode the visit from a new patient visit to a established visit? Just wondering because I know you need all 3 elements to code a new patient code.

 

[suemt]

Has the patient been seen by the practice or the physician within the past 3 years? That is the distinction between new and established.

 

[tammyj0212]

It is a new patient but there is no HPI so how would you code a new patient?

 

[mlbaker1974]

In order to bill a new patient visit all 3 of the key components must be met and the patient cannot have seen any provider in this practice within the past 3 years. You may not downcode to an established patient encounter, that is purposefully misrepresenting what happened in the encounter.

 

[LGillstrom]

Please help!

If a patient comes in for a consult before a procedure and there are no presenting problems meaning there is no HPI can I downcode the visit from a new patient visit to a established visit? Just wondering because I know you need all 3 elements to code a new patient code.

You should never "downcode" from a new patient visit to an established patient visit when a patient is, indeed, a new patient.

In the scenario you presented, I would recommend querying the provider, and asking them to provide additional documentation. The service, if not meeting the "three of three" criteria for a new patient visit is not reportable.

 

[Tonyj]

Please help!

If a patient comes in for a consult before a procedure and there are no presenting problems meaning there is no HPI can I downcode the visit from a new patient visit to a established visit? Just wondering because I know you need all 3 elements to code a new patient code.

The consult is for what procedure? Wouldn't he/she asses the patient before the procedure?

 

[Saedron]

Correct me if I'm wrong, but in the absence of HPI the provider CAN comment on 3 chronic conditions to qualify the HPI portion of the E/M.