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Yearly visits and E&M visits New Patient

  1. #1
    Default Yearly visits and E&M visits New Patient
    Medical Coding Books
    Our office is starting to see M.D.'s seeing New Patients for their Yearly Exams, charging for the yearly and then also charging an E&M level (new Pt) for a problem that is found. We're seeing an insurance company denying the E&M because it wasn't coded as an established visit. We're being told not to charge both as "new". The Yearly is supposed to be charged as a New Pt visit and then the E&M as "Established". Has anyone else seen this and is there a rule to follow or is this rule probably insurance company specific?

    Judy V Minneapolis, MN

  2. #2
    This is a topic that will inspire heated discussions.

    I personally agree with what the insurance company is telling you and that is how we bill when this situation arises.

    CPT states the well care codes can be billed with 99201-99215 as appropriate, so it seems to support use of 2 new patient codes on the same patient.

    My opinion is CPT is contradicting itself in saying that.

    Bottom line you will have to play the carriers game to get paid or fight it out to try and get them to change.

    Laura, CPC, CEMC

  3. #3
    Greeley, Colorado
    I agree with Laura.
    Lisa Bledsoe, CPC, CPMA

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