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99401 and New vs. Established Patient

  1. #1
    Location
    Overland Park, KS
    Posts
    1,166
    Default 99401 and New vs. Established Patient
    Medical Coding Books
    I have a question that I hope someone canhelp clarify for me. I think I know the answer to this, but I guess I just need some reasuurance.

    A new patient comes into our clinic and all we perform is preventative counseling, CPT code 99401. The patient had no symptoms. I am aware that the CPT book states that code 99401 can be used for either a new or an established patient, but if the patient was new and all we did was the counseling only, code 99401, if the patient returns to us for a sick visit a few weeks later, are they now an establsihed patient?

    Now, I say yes because an E/M service was created on the intial visit, but I have a few coders in my office challenging this.

    Any opinions? Thanks.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Why would they challenge this? The patient was in the office face to face with the physician for services rendered, they are now established. I could be mistaken but I know of no ruleing that cetain services do not count as to make the patient new for the next encounter.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    I totally agree with you. Why would they challenge this? That is a good question! I agree that they would be established on the return visit, but I guess the coders are thinking that because the patient had no symptoms, they never "established" care.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Tell them that preventive counseling is preventive "care", so care has been established.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    I could not agree with you more! Thanks again.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

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