New Vs Established with 99211

gailmc

Networker
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84
Location
Shoreview, MN
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If a new patient comes into a clinic for a flu shot and then returns a few weeks later for a office visit, is the patient new or established at this point?

Does it make a difference if we billed a nurse only visit for the initial visit?

I know CPT indicates if patient has received a professional service in the past three years, the patient would be established.
Does this count if the patient only saw a nurse but a provider signed off on the flu vaccine order?
 

dabroussard

Networker
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Technically, it doesnt matter. If you read the description of a 99211 it states visit for the evaluation and management of an established patient. There isnt a true E&M for a new patient for a nurse visit. Logic is a new patient shouldnt be seeing the nurse before being seen by a provider.
 

Jackie Stack

Networker
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I believe that a nurse should not give immunizations to a patient who has not established in your office. I would not charge a 99211 or nurse visit for an immunization.

I think if you charge for any service they would now be an established instead of new patient.
 

cynthiar

Networker
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67
Location
Greensboro, NC
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I agree, they now have contact with your office, so they are an established patient, because they are not new to your practice.
 

cedwards

Guru
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Hamden
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I agree...I think they would be established since they have received professional services from your group.
 

jharrell

Networker
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I disagree. The e/m guidelines says, " A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group pratice,..."

So this pt only came in for a flu shot and didn't see the physician, we do this all the time in our clinic. Also I would not use a 99211 for this pt.

Jessica Harrell, CPC
 

rthames052006

True Blue
Local Chapter Officer
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York, Pa
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I disagree. The e/m guidelines says, " A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group pratice,..."

So this pt only came in for a flu shot and didn't see the physician, we do this all the time in our clinic. Also I would not use a 99211 for this pt.

Jessica Harrell, CPC
I agree with you 100% Jessica, why would you bill a 99211 for a flu shot, wouldn't you be using the administration of flu vaccine and the charge for the actual medicine.

Just my thought
 
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