Results 1 to 5 of 5

Establishing Care without complaints

  1. #1
    Default Establishing Care without complaints
    Exam Training Packages
    Hello all,
    If a patient comes in to establish care, doesn't have any complaints, and only a minimal exam is done, is that a billable visit? Nothing's documented that could be construed as preventive counseling and since the exam was limited to vitals & listening to the lungs & heart, I don't think it meets the requirement to bill the Initial Comprehensive Preventive Medicine codes. Does anyone bill for these type of visits? If so, do you bill the pt or the insurance? My concern is that there isn't any medical necessity to the visit if you don't do enough to even bill for codes 99381-99387. Thanks for any opinions on the matter!
    Sue Vermette, CPC

  2. #2
    Default
    I re-read your note, and I am confused. If this an initial visit or an established pt. Why would the patient be coming into your facility without a reason. You are right about the medical necessity. You must have a chief complaint. If this is a follow-up visit, you can construde that to be the cheif complaint, but it doesn't sound like you have a billable visit.
    Last edited by krssy70; 01-06-2010 at 01:02 PM.
    Kristen Richard, CPC

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default "Get to know you" visits
    These are "getting to know you" visits ... typically someone has moved to your area and needs to get established with a new primary care physician. No complaint, no issues, just needs to get established.

    There are three possible ways to go here.

    Option 1 - consider it a cost of doing business, and good customer service. Don't bill anything. Perhaps use a dummy code for tracking purposes.

    Option 2 - Use the Unlisted E/M 99499 and bill at a relatively low cost.

    Option 3 - Bill the patient directly for a non-medically necessary visit.

    I like Option 1 myself. That means that when the patient actually presents for a full physical or sick visit you will be using a new patient code vs established patient.

    NOTE - I am talking about a visit with NO exam, NO Rx, NO complaint. At most you might have a history form filled out and a form to request copies of records from the previous physician.

    Whatever your practice decides, put your policy in writing and treat ALL such patients the same way.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by SUEV View Post
    Hello all,
    If a patient comes in to establish care, doesn't have any complaints, and only a minimal exam is done, is that a billable visit? Nothing's documented that could be construed as preventive counseling and since the exam was limited to vitals & listening to the lungs & heart, I don't think it meets the requirement to bill the Initial Comprehensive Preventive Medicine codes. Does anyone bill for these type of visits? If so, do you bill the pt or the insurance? My concern is that there isn't any medical necessity to the visit if you don't do enough to even bill for codes 99381-99387. Thanks for any opinions on the matter!
    In our practice these visits are treated as preventive. Of course, the provider performs the necessary exam, so that's different than your scenario. The medical necessity is that the provider needs to get to know the patient too.
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Default Thanks
    We've said in the past that these "meet & greets" are done more as a courtesy so aren't billable but sometimes they sneak thru from the provider. Thanks for your suggestions!
    Sue
    Sue Vermette, CPC

Similar Threads

  1. What is the best ICD 9 to bill for establishing care
    By pamelat in forum Diagnosis Coding
    Replies: 10
    Last Post: 05-28-2015, 06:15 PM
  2. Establishing Care -What dx code should
    By amber2262 in forum Billing/Reimbursement
    Replies: 1
    Last Post: 05-14-2013, 09:40 AM
  3. Establishing Care - new pt exam
    By calexander1265 in forum Pediatrics
    Replies: 3
    Last Post: 10-23-2011, 06:46 AM
  4. Establishing Care
    By amaxines in forum Billing/Reimbursement
    Replies: 1
    Last Post: 03-23-2010, 07:00 AM
  5. Replies: 1
    Last Post: 05-08-2009, 03:52 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.