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Thread: Exam portion when 3 out 3 must me met

  1. #1

    Default Exam portion when 3 out 3 must me met

    AAPC: Back to School
    If my physician sees a new pt. and does a history and D/m but no exam, he does state "the patient's history and exam is stable from Dr.xxxxxxx recent dictation."
    He does not state the date of that recent dictation.

    My question is can I bill this if he didn't do the exam, this pt. is new and we must meet three out three to get the level. Time is not documented so I can not bill based on time.

    Any thoughts, please,
    Marci Klaubauf, CPC

  2. #2
    Join Date
    Apr 2007


    This is when you would need to use 99499 and submit the documentation to the insurance carriers.

    You must either do time or all 3 key components for a new patient E/M. I would advise the provider that his service is only billable as an unlisted code if he doesn't do everything required. It is hard to get unlisted codes paid and takes a lot longer to received the money than a new patient code.

    Good luck,

    Laura, CPC

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Laura is correct ... BUT

    But I have a question ... If this is a new patient how is it that there is any dictation to refer to?

    In any case ... you cannot simply refer to another physician's exam in your dictation and have that count. The exam as documented should be a report of THIS physician's findings him/herself, i.e. what s/he saw, observed on examining the patient.

    Hope that helps

    F Tessa Bartels, CPC, CEMC

  4. #4
    Join Date
    Apr 2007
    Boston, MA


    I fully agree with Laura and F Tessa.

    Perhaps I can imagine the reasoning your doc may have had by doing the exam and finding everything as documented by someone else - thus making a notation that everything is still the same, BUT...
    -> "if you didn't document it, you didn't do it" (and this is one of Medicare's mantras)
    In other words, if you do the work, you might as well document to be able to take the credit.
    Karolina, CPC, CPMA, CEMC

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