Ped patients w/congenital anomalies

[VRMoran]

I have a patient that has not been seen since 11/2007 and now came in for a check-up I corrected the code from a 99213 to a 99203. The provider does not agree with me, he state that a pediatric patient with congenital anomalies are established patients who may be seen at 1-5 year intervals as part of their regular follow-up, has anyone heard of this?

 

[FTessaBartels]

I have the same problem

I have had the same discussion with my plastic surgeons who follow pediatric patients for many years after their initial surgery.

The CPT rules are clear, however. A patient who has not been seen for more than 3 years, is considered a new patient. The reason for this is that a long interval between visits will require more work on the part of the physician to complete a history and work-up the patient.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[VRMoran]

Thank you

Your answer was very helpful. Thank you again

 

[zanalee]

if you are changing 99213 to new patient the highest level you can get is 99202 for a new patient.