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New patient visit

  1. #1
    Default New patient visit
    Medical Coding Books
    I have a new patient presenting for an annual visit and a problem visit. Do you code both the problem visit and preventive visit as a new or the preventive visit as a new and the problem as established? I've been hearing conflicting information on this problem and can not find the answer in writing. Can someone help, please?

  2. Default
    I would bill both as new, however, I too have seen conflicting information on this.

  3. #3
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    CPT states (Pg 29 in my book) to select the appropriate office code 99201-99215 for the problem oriented visit. Modifier 25 should be added to the office visit to indicate a significant, separetly identifiable E/M service.

    I do recommend that you check with the particular carrier in question. Some carriers do have unique billing guidelines for this scenario.

  4. #4
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    If you separate this and see it as actually two visits then the way I see it is they were a new patient for the annual then they had to be established for the office. You cannot bill both as new. However Rebecca is correct, you do need to check with the payers on this one and ask if they allow split billing.

  5. #5
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    Quote Originally Posted by mitchellde View Post
    If you separate this and see it as actually two visits then the way I see it is they were a new patient for the annual then they had to be established for the office. You cannot bill both as new. However Rebecca is correct, you do need to check with the payers on this one and ask if they allow split billing.
    I agree. We code the annual as new and the problerm oriented visit as established.
    Lisa Bledsoe, CPC, CPMA

  6. #6
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    *nodding in agreement with Lisa and mitchellde* though we've been down this road before in other forum chats...

    others seem to think you can be a new patient "twice".. but,..once you're seen for that "initial" new patient physical or E/M... the next visit (at least the way I read the guidelines)...is established.

    we typically code the preventive as a NEW PT, and the E/M as established - documentation supporting both services of course...
    Donna, CPC, CPC-H

  7. #7
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    I am confused here .Why one is new and another is established?

    New patient one who has not received any professional svcs form th physician or another physician of the same specialty who belongs to the same group practice ,within the past three years

    I think it should be both (preventive & office visit) new visit or both established visit

    waiting for feedback

    Thankyou

  8. #8
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    The thought is the patient is scheduled for a preventive visit and they meet the definition of a new patient. The preventive visit is done therefore a service has been provided and they are now established. During this visit a problem is discovered and treated. Based on CPT once a face to face service has been provided they are now established, so the probem visit would then be reported as an established E/M.

    So you have a new preventive with an established problem visit.

    Laura, CPC

  9. #9
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    While I see others point of view....still check with your carriers. UHC plainly states they will pay for a new problem oriented visit with a PE if the patient is indeed new. Below is an excerpt from their policy.

    Preventive Medicine services [Current Procedural Terminology ( CPT ® ) codes 99381-99387, 99391-99397, Healthcare Common Procedure Coding System (HCPCS) code G0402] include annual physical and well child examinations, usually separate from disease-related diagnoses. Occasionally, an abnormality is encountered or a pre-existing problem is addressed during the Preventive visit, and significant elements of related Evaluation and Management (E/M) services are provided during the same visit. When this occurs, UnitedHealthcare will reimburse the Preventive Medicine service plus 50% of one of the following problem-oriented E/M service codes only--99201-99205 or 99212-99215--when that code is appended with modifier 25. If the problem-oriented service is minor, or if the code is not submitted with modifier 25 appended, it will not be reimbursed.
    Last edited by RebeccaWoodward*; 06-05-2009 at 05:22 PM.

  10. #10
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    Quote Originally Posted by katmryn78 View Post
    The thought is the patient is scheduled for a preventive visit and they meet the definition of a new patient. The preventive visit is done therefore a service has been provided and they are now established. During this visit a problem is discovered and treated. Based on CPT once a face to face service has been provided they are now established, so the probem visit would then be reported as an established E/M.

    So you have a new preventive with an established problem visit.

    Laura, CPC
    Laura- NICELY stated - that's how I interpret the guidelines as well.
    Donna, CPC, CPC-H

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