Wiki new vs established patients

[kmaher]

If a patient is new but the documentation doesn't support billing a new patient code what are the guidelines for billing this as an established patient? Is this allowed or is this non-billable? If you have something that I can reference to show a physician it would be greatly appreciated.

 

[DebbiePottsEngland]

Your best bet would be to contact your insurance provider. each has their own set of rules for this occasion.
sorry there is no hard and fast rule for this.

 

[MikeEnos]

It doesn't even qualify as a level 1 new patient? Problem focused history, exam, and straight-forward MDM? Or just 10 minutes mostly spent counseling?

 

[MnTwins29]

It doesn't even qualify as a level 1 new patient? Problem focused history, exam, and straight-forward MDM? Or just 10 minutes mostly spent counseling?

I agree with Mike - you can get all three elements from minimal documentation. If the history only has one statement of the current problem - get one HPI element and that is enough for a problem focused history.

Only vitals were taken? Well, if the doctor documents he reviewed them, that is enough for a PF exam, under the constitutional element.

MDM - again, even minimal documentation will work. You have a diagnosis/problem somewhere - and what did the doctor do, even if he just sent the patient home? He still made a decision (sounds like a song - you've still made a decision if you haven't decided!)
and I would be surprised if you couldn't justify SF MDM.

And there you go - all three elements at a minimum level - 99201.

 

[Tonyj]

If a patient is new but the documentation doesn't support billing a new patient code what are the guidelines for billing this as an established patient? Is this allowed or is this non-billable? If you have something that I can reference to show a physician it would be greatly appreciated.

Just curious, why doesn't it meet new patient guidelines?