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can you use 2 new pt codes at same visit?

  1. #11
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    Perhaps it is a contractual issue with some carriers to pay both new. However, I have never seen Medicare pay two new visits.
    Lisa Bledsoe, CPC, CPMA

  2. #12
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    Quote Originally Posted by Lisa Curtis View Post
    Perhaps it is a contractual issue with some carriers to pay both new. However, I have never seen Medicare pay two new visits.
    Since this was posted in the "Ped" forum, I assumed we were speaking about a commerical carrier. Additionally, you wouldn't bill MCR for a new wellness and new problem oriented visit since a preventative exam is not a payable benefit (other than the IPPE); which could be payable with a new problem oriented visit.

  3. #13
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    Good point about Medicare Rebecca. I failed to notice that this was in the Pediatric forum.
    Lisa Bledsoe, CPC, CPMA

  4. #14
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    I just wanted to comment on the logic of coding "to get paid" vs "correct coding"
    Of course I understand we need to get paid!
    But we as coders should not bow down to greedy insurance companies.
    It is our responsibility to code correctly! regardless of how insurance companies reimburse!
    We need to set the standard, be a united front on correct coding and eventually the insurance companies "should" follow....just my opinion!
    Tina

  5. #15
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    Quote Originally Posted by tosullivan View Post
    I just wanted to comment on the logic of coding "to get paid" vs "correct coding"
    Of course I understand we need to get paid!
    But we as coders should not bow down to greedy insurance companies.
    It is our responsibility to code correctly! regardless of how insurance companies reimburse!
    We need to set the standard, be a united front on correct coding and eventually the insurance companies "should" follow....just my opinion!
    Tina
    Tina - I hope you don't think I am an advocate of "coding to get paid". What I want for my providers is payment for the services that they provide. If that means coding one new and one established E/M as this scenario states, that is what needs to be done. Just because the AMA puts out CPT and guidelines doesn't mean that those guidelines are interpreted the same way by everyone. I agree that we as coders should set the standard and code correctly...the issue is the interpretation of guidelines by multiple individuals vs the insurance companies. In my organization I am not involved in the contract agreements nor is my input requested. The insurance companies set their policies whether we agree with them or not, and if we have a contract we must abide by that contract. I am not suggesting any kind of false coding, I am suggesting that we follow the policies of the contracts we have. That or have no contracts, which would leave us without patients to treat. Just my thoughts.
    Lisa Bledsoe, CPC, CPMA

  6. #16
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    I agree. Just to reiterate...CPT address' a New wellness visit in addition to a new patient, problem oriented visit. CPT's instruction:

    If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem or abnormality is significant enough (emphasis mine) to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate office/outpatient code 99201-99215 should also be reported.

    This is not an insurance directive but rather CPT.

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