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New patient visit

  1. #21
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    Medical Coding Books
    Quote Originally Posted by katmryn78 View Post
    Per CPT guidelines professional services are those face-to-face service rendered by a physician and reported by a specific CPT code.

    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 or practice within the past three years.

    Where in the guidelines does it state you are new for a whole day? If that same patient is seen at 8am for a yearly and comes back after lunch with possible food poisoning is that 2nd visit new?

    Laura, CPC
    I say nope..not new...establish
    Donna, CPC, CPC-H

  2. #22
    Location
    Columbia, MO
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    I agree with Donna, 2nd visit = estb.

  3. #23
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    North Carolina
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    The AMA has this policy in place for a reason. Is it subject to change in the future...maybe/probably....

    #1- Our providers are already at the mercy of our carriers edits and their self enforced policies. I , for one (not to suggest anyone isn't ) am a provider advocate. If there is a policy in place that allows a provider to benefit, such as this, I will try within my means to obtain this additional payment. What I mean by this...IF a carrier has an unclear policy regarding this scenario, I am going to fight for that extra revenue. I'm going to point out that the AMA has a guideline in place. As it is now, I can name many, many coding guidelines (even taught to this day by the AAPC) that the carriers manipulate for their benefit yet we become complacent, step aside and say nothing. I am curious about one thing... for those of you whose providers conduct a wellness PE and the patient then presents a problem oriented issue, do you allow the provider to charge for the New PE and a New problem oriented OV? Or...do you offer your opinions, such as those posted on this thread, and reduce their problem oriented visit (w/ provider input of course)...even if your carrier allows both, new, sevices? If so...are those providers aware of what CPT states? My providers certainly are.

    #2-For any instructors out there that read this topic, I would really, really like to know what you presently teach your students or what your view is on this topic since the guidelines are there in black and white (or so I think).

    I am not trying to sound unreasonable, hostile, etc.... I am, however, tired of justifying my providers coding when there are policies in place that are suppose to be in their favor. My job is to uphold, to the best of my ability, the guidelines that are set forth by the AMA and CMS.
    Last edited by RebeccaWoodward*; 06-09-2009 at 07:18 AM.

  4. #24
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    Morning Rebecca - (not trying to argue either) . Yes, my providers are aware of the decision tree for "new vs est"... and yes, they clearly understand that once services are provided to a patient by them, or another provider of the same specialty/group, then that patient is no longer considered "new" UNLESS they haven't been seen within 3 years.

    Actually "THIS" is what I was taught in school... by my instructors.

    regarding page 29 of the CPT book - (and I think we may have discussed this point before as well)... it says "if the problem/abnormality is signifcant enough to require additional work to perform the key compoentnes of a problem -oriented E/M service, then the appropriate Office/Outpatient code 99201-99215 also be reported. Modifier 25 should be added to the Office/Outpatient code"

    it says "appropriate" ..it doesn't say "NEW"...doesn't say "EST"..it says appropriate..
    the way I was taught, and the way I see it - if you use what's on page 29 and page 2 - the appropriate code would be an est E/M with a .25 modifier

    anyway... I think it's clear by our posts that we all feel pretty strongly in our opinions ...I just wanted to post that yes, my providers know the new/est rules and how it's coded out when on the rare occasions they have a new preventive and an "above/beyond" E/M which is considered est.

    NEW INFO.........

    however - ! I put a question in to a contact I have (very smart person, I knew she'd point me to a source stating clearly, one way or the other) and she did, to the CPC Assistant October 2006, Volume 15, Issue 10, Page 15 - in where it states the following: (and this is just an excerpt)
    Therefore, if preventive medicine services and an office or other outpatient service are each provided during the same patient encounter, then it is appropriate to report both E/M services as new patient codes (i.e., 99381-99387 and 99201-99205, as appropriate), provided the patient meets the requirements of a new patient based upon the previously noted guidelines.

    goes on to say....

    If, however, the acute visit (i.e., office or other outpatient service, 99201-99215) is performed on a date subsequent to the new patient preventive medicine service and within 3 years, then it would be appropriate to report the established office or other outpatient visit code (i.e., 99211-99215, as appropriate).

    so there it is, in black and white (not grey).

    I stand corrected! Rebecca THANKS for continuing to post your view! I respect your opinion very much, and that's why I started researching my own understanding of the discussion/debate a bit more.. I'm glad I did! as I said in another post...I'm always learning something new OR being reminded of things I may have forgotten! THANKS AGAIN!!
    Last edited by dmaec; 06-09-2009 at 08:33 AM.
    Donna, CPC, CPC-H

  5. #25
    Location
    North Carolina
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    That's what I love about ya, Donna...gutsy! Yes...we do view this differently. I'm a "matter of fact" kinda gal. If the passage exists, when do you allow a new problem oriented? It would seem never in some of these views. In any case...I like these spicey conversations. Have a good one!

  6. #26
    Location
    Columbia, MO
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    Way to go! I had not read that issue either, so we all learned something today, expect for Rebecca who knew it all along! Good going Donna!

  7. #27
    Location
    North Carolina
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    Thank you for posting this, Donna. I, too, respect your comments and views. Between being born in the North and living in the South, I'm often viewed as a big mouth with a hint of southern slang....... Again...this forum is incredible. I hope the AAPC realizes how lucky they are to have you guys!

    TWO THUMBS UP!

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