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new visit vs well woman?

O

OnelM2023

Networker
Messages
46
Location
Cape Coral, FL
If a new patient comes in our office for a well woman cpt:99683, can we still code 99244 for next visit as a new consult since the first visit was a well woman?

big difference in accounting!!!

Please help!!!


:confused:
 
Established patient

If the patient's next visit to you (after an initial well woman exam) is initiated by her directly or by your office scheduling a follow-up, then that visit is an established patient visit.

IF ... (Big BIG IF) ... the patient's PMD has requested a consultation for some medical problem, then of course you may code the appropriate consult. (The PMD referring the patient to you because it's an insurance requirement of her HMO is NOT the same thing as the PMD requesting a consultation - your advice/opinion on management of a problem.)

F Tessa Bartels, CPC, CEMC
 
thank you very much. pretty new at this...this was a big help...its just that if a woman comes to our office for the first time and its a well woman (99683) then from there on if she comes back its a 99213 as a f/u. This means we can never bill her for 99244, that gives us more income? I hope Im explaining myself !!
 
Established patient

Look at your CPT E/M guidelines (2009 professional edition, page 1):
A new patient is one who has not received any professional services from the physician ... within the past three years. (emphasis added by FTB).

This is very clear. ANY profesional services. A well woman exam is a professional service. (I assume you mean CPT 99386)

Also ... her subsequent visits will not always be 99213 ... The level of established patient visit will depend on the presenting problem, and the documented E/M. And subsequent visits might also be 99396 (established patient preventive exam).

Don't code for the reimbursement. Code according to the guidelines.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
New Patient w/ Problem

One more thing ...

The new patient may have initially scheduled a "well woman" exam (99386), but if the physician encountered a problem that required evaluation and management separately from the usual preventive exam, you can code the new patient visit at the same time. You need to carve out the specifics of each type of visit in the documentation (two notes would be ideal).

The key here is that both services occur on the same date ... the patient is still "new."

For example, I go to see a new physician to establish care - routine physical.
While there, I mention that I also have a persistent cough, for which he does some additional evaluation, and prescribes a cough suppresant. He can code both the preventive visit and the new patient visit if he has documentation to show two clearly separate types of service. (And you'd use mod -25 on the new patient visit code.)

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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