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New patient Preventative and problem exam

  1. #1
    Default New patient Preventative and problem exam
    Medical Coding Books
    If a patient comes in to establish with a physician and he performs both preventative and problem exams are they both coded as new patient?
    Thanks

  2. Smile
    yes, as long as this is indeed the patients first time to be seen by this
    physician. also, keep in mind new patient is one who has never been seen,
    or seen within the last 3 years.

  3. #3
    Default
    correct, don't forget to add your 25-modifier.

    Roxanne Thames, CPC







    Quote Originally Posted by cynthiaj54 View Post
    If a patient comes in to establish with a physician and he performs both preventative and problem exams are they both coded as new patient?
    Thanks

  4. #4
    Default
    I don't know if I agree with this one. Remember a new patient visit needs 3 out of 3 components to determine the level. You cannot double dip on the exam. Your preventive visit should be coded as a new preventive, but the office visit should be established. It is easier to carve out the established visit with 2 out of 3 components being the history and medical decision making.

    Both visits should stand alone - without double dipping. Most payers too, will deny two New E/M's on the same day.

    Good luck.
    E. Frohna
    Evangelina Frohna, CPC, CEMC

  5. #5
    Default
    Per CPT: If an abnormality/ies is encountered or a pre existing problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem/abnormality is Significant enough to require additional work to perform the key components of a problem-oriented service, then the appropriate Office/Outpatient code 99201-99215 should also be reported.
    In my opinion, if CPT meant for an established patient code to be billed only with the new patient preventive example above,the codes starting within the New Patient range starting with 99201 would NOT be referenced as one of the codes applicable.


    Roxanne Thames, CPC













    Quote Originally Posted by efrohna View Post
    I don't know if I agree with this one. Remember a new patient visit needs 3 out of 3 components to determine the level. You cannot double dip on the exam. Your preventive visit should be coded as a new preventive, but the office visit should be established. It is easier to carve out the established visit with 2 out of 3 components being the history and medical decision making.

    Both visits should stand alone - without double dipping. Most payers too, will deny two New E/M's on the same day.

    Good luck.
    E. Frohna

  6. #6
    Default
    RThames,
    I didn't say you can NEVER bill 2 New E/M's on the same day. I'm only cautioning the double dipping on the exam component. Both visits should stand alone, if you are going to bill 2 new. Also, some payers not all, will deny one of them.
    Good luck.
    E. Frohna
    Evangelina Frohna, CPC, CEMC

  7. #7
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Just want to point out that no payer will reimburse for two new patient visits on the same date; so Efrohna is correct in the suggestion to code the new patient preventive medicine and the established problem oriented visit.
    Lisa

  8. #8
    Default
    Quote Originally Posted by efrohna View Post
    RThames,
    I didn't say you can NEVER bill 2 New E/M's on the same day. I'm only cautioning the double dipping on the exam component. Both visits should stand alone, if you are going to bill 2 new. Also, some payers not all, will deny one of them.
    Good luck.
    E. Frohna
    E. Frohna,

    Not a problem at all.... I tried emailing you privately... I wanted to say that I guess I am so used to having to defend myself (with the md's I work for) that I do get defensive, and I wanted to apologize... Sorry................

    I think after 11 years with these guys I'm getting in a "burn out" mode... I think it maybe time to find a new coding job with another group.

    Have a good weekend.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  9. #9
    Location
    Central Arkansas
    Posts
    20
    Default
    Yes you can just append the modifier -25.

  10. Default New preventative with new patient problem exam
    How can we find out if both are appropriate? Our MD's want to bill both new preventative examination and new patient examination? Is there any where that states "NO" or "YES"?

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