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Thread: New Patient then Pre-op visit

  1. #1

    Default New Patient then Pre-op visit

    AAPC: Back to School
    Our GYN oncologists see new patients in consultation on referral for suspected gynecologic malignacies, and often surgery is scheduled quickly. Often the New Patient visit and the Pre-Operative Exam are within the same 7-10 day period. Both the new patient visit and pre-op exam are level 5 visits. What is the general rule for billing for these services? Can we bill both of these e/m visits so close together?

    Thanks in advance for your help.

  2. #2
    Join Date
    Apr 2007


    I believe you would be using 99205 for a new pt and then the subsequent office visit follow-up 99215, yes? Are these true consults or is care being transferred...need some more details?

  3. #3


    Quote Originally Posted by kalbright View Post
    I believe you would be using 99205 for a new pt and then the subsequent office visit follow-up 99215, yes? Are these true consults or is care being transferred...need some more details?
    Yes we are billing the 99205 or 99245 and the 99215. My question is more about these visits being as close as 3 days apart. Very rarely do things change in such a short period of time and I do not want to "double dip". Our physician is doing the work and documentation is complete.

  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default No pre-op exam

    Your first visit with the patient is either a consultation or a new patient visit, depending on whether the requesting/referring physician is asking for advice/opinion or already knows surgery is needed and is transfering care for that purpose.

    If the decision for surgery is made at the first visit, and the surgery is scheduled quickly ... say in 7 days. And then you bring the patient back for a pre-op visit 3 days before surgery ... that pre-op visit is NOT billable. What's the medical necessity for it? Just because the hospital requires an H&P performed within 72 hours of admission is not medical necessity. That service (the H&P visit) is included in the RVU of the surgery. Makes no difference if the documentation would otherwise show a level 1 or level 5 visit.

    However ... There may be other scenarios where it is medically necessary to have another visit before surgery. That type of visit is coded using the established patient codes (99211-99215).

    I hope I've helped you.

    F Tessa Bartels, CPC, CPC-E/M
    Last edited by FTessaBartels; 11-21-2008 at 01:18 PM.

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