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Diagnosis for new patient

  1. Cool Diagnosis for new patient
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    I have a new patient that was seen in our office to establish care. Our provider did the usual new patient workup, but the patient didn't have anything going that I can attach a diagnosis code to. They didn't do a physical, so I don't want to use a wellness code. She is due for a physical in the spring, so I know if I use a wellness code that will cause a rejection when I bill her physical. Has anyone had this situation arise, and did you find a suitable code? Thanks!

  2. #2
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    There is a code that is suitable to use V65.5 which is used when there is comething they think is feared that they may have and it is "normal exam". Hope this helps!

  3. #3
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    What did they do?

    I wouldn't use the feared complaint because there wasn't one. I would use the V70.0 but I am curious when you say no physical was done. It almost sounds like all they did was history if you have no dx and from the sounds of it no exam. In that case, unless they documented time, you can't use a new patient code. Of course I'm not keen on using 99201-99205 when there is no complaint anyway, regardless of what CPT assistant might say in some cases.

    This almost sounds like a meet and greet to me, in which case we don't charge anything in our offices. That way when they do come back for an actual problem or physical we can use the proper new patient code.

    Laura, CPC, CPMC, CEMC

  4. #4
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    Quote Originally Posted by katmryn78 View Post
    What did they do?

    I wouldn't use the feared complaint because there wasn't one. I would use the V70.0 but I am curious when you say no physical was done. It almost sounds like all they did was history if you have no dx and from the sounds of it no exam. In that case, unless they documented time, you can't use a new patient code. Of course I'm not keen on using 99201-99205 when there is no complaint anyway, regardless of what CPT assistant might say in some cases.

    This almost sounds like a meet and greet to me, in which case we don't charge anything in our offices. That way when they do come back for an actual problem or physical we can use the proper new patient code.

    Laura, CPC, CPMC, CEMC
    Hi Laura, does that mean that even thought the patient has had a meet and greet, they can still be charged as a new patient if they come back again? I thought that if the patient has already been seen that it would be an established patient on the next visit. How does this work with the meet & greet. Maybe that is where I am confused. I only ask because I am still learning a lot about E&M and I don't code for clinics so this is new to me.

  5. #5
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    Columbia, MO
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    I am with Leslie on this. I think once you see the patient they are established whether you charged for the visit or not. In my opinion this sounds like a preventive encounter and I would code it that way. If the patient has already had a preventive for the year then they will have to pay out of pocket. Or if they have no preventive coverage they will pay out of pocket.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Default Meet and Greet
    CPT defines professional services as those that are face to face rendered by a physician and reported by a specific CPT code(s).

    A meet and greet does not meet the definition of any specific CPT code. Generally when we do a meet and greet, the patient comes in talks to the doctor signs forms to get records from other providers and just goes over general practice issues (Rx call ins, whether or not they round at the hospital, etc). There is no exam, no MDM, and time is usually minimal.

    So we don't bill anybody anything. Since we are not reporting any CPT codes the patient still meets the definition of a new patient.

    Laura, CPC, CPMA, CEMC

  7. #7
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    Thanks, Laura. I will a note of that in my notes

  8. Default
    The patient isn't due for her physical yet this year, that is why I haven't used the V70.0. The provider did ROS X10, PE X8, family and social history. She also had flu shots done on that day, not sure if that makes any difference. I really don't like the meet and greet idea, we don't do those because it is so much time from the schedule for a free visit. I am thinking maybe bill a new, nurse visit if nothing else.

  9. #9
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    There is no new nurse visit.

    The patient not being due for a physical doesn't mean that wasn't what was done. That is probably an insurance limitation so it is a benefit issue not a coding issue.

    The right way to code this would be the preventive codes.

    Laura, CPC, CPMA, CEMC

  10. #10
    Location
    Columbia, MO
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    I agree with Laura it sounds to me like the patient is wanting a free visit here. Why would a patient seek out a new physician with no problems or complaints and it is not time for a yearly preventive. HMMMM I just have concerns on this. It reads preventive to me and that is how I would do it. Like Laura stated the whole not time yet is a benefit issue not a coding issue.

    Debra A. Mitchell, MSPH, CPC-H

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