Wiki NEW PATIENT well and sick visits for the same encounter

[tg]

Hello,

We have received denials when billing a new patient well and new patient sick visit for the same encounter. It seems to me that this is okay as CPT and CPT assistant both say to code 99201-99215 for the additional problem-oriented work, obviously stating the new patient code too. To bill a new patient well together with an established patient sick would also be incorrect as the patient is a new patient. Would anyone know what protocol is in the scenario and from where I could back it up?

Thank you for your help.

 

[Chelle-Lynn]

Just confirming that you are placing the modifier 25 on the 99201-99215?

 

[tg]

Yes, we are.

 

[espressoguy]

I'm pretty sure that even though the visits are concurrent, you would bill the wellness visit as new and the sick visit as established. The patient is only new to the provider/practice once within a 3 year period, so you can't bill 2 new patient codes.

 

[tg]

Even if it's on the same day?

 

[teresabug]

I had read somewhere that both codes would be new. Check out aafp.org
and do a new patient search. I think this is where I read this.

 

[lgardner]

after much research and discussion...our office bills both as new patient visits.

 

[a.renee86]

You would bill the wellness as new and the sick visit as est. You cannot bill 2 new patient visits on the same day. Even though the patient is technically 'new' the well visit is taking care of the establishing discussion.

We had a company auditor come in and explain this scenerio to our office and our providers just yesterday.

 

[tg]

Thank you all for your input. This is obviously a divided issue. I contacted our MAC. Hopefully they will have an answer for us.