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New Vs Established with 99211

  1. #1
    Location
    Minneapolis MN
    Posts
    84
    Default New Vs Established with 99211
    Medical Coding Books
    If a new patient comes into a clinic for a flu shot and then returns a few weeks later for a office visit, is the patient new or established at this point?

    Does it make a difference if we billed a nurse only visit for the initial visit?

    I know CPT indicates if patient has received a professional service in the past three years, the patient would be established.
    Does this count if the patient only saw a nurse but a provider signed off on the flu vaccine order?

  2. Default
    Technically, it doesnt matter. If you read the description of a 99211 it states visit for the evaluation and management of an established patient. There isnt a true E&M for a new patient for a nurse visit. Logic is a new patient shouldnt be seeing the nurse before being seen by a provider.

  3. #3
    Default
    I believe that a nurse should not give immunizations to a patient who has not established in your office. I would not charge a 99211 or nurse visit for an immunization.

    I think if you charge for any service they would now be an established instead of new patient.

  4. #4
    Location
    Greensboro, NC
    Posts
    67
    Default
    I agree, they now have contact with your office, so they are an established patient, because they are not new to your practice.

  5. #5
    Default
    I agree...I think they would be established since they have received professional services from your group.
    Christina Lee Wagner, CPC, CPC-H

  6. #6
    Default
    I disagree. The e/m guidelines says, " A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group pratice,..."

    So this pt only came in for a flu shot and didn't see the physician, we do this all the time in our clinic. Also I would not use a 99211 for this pt.

    Jessica Harrell, CPC

  7. #7
    Default
    Quote Originally Posted by jharrell View Post
    I disagree. The e/m guidelines says, " A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group pratice,..."

    So this pt only came in for a flu shot and didn't see the physician, we do this all the time in our clinic. Also I would not use a 99211 for this pt.

    Jessica Harrell, CPC
    I agree with you 100% Jessica, why would you bill a 99211 for a flu shot, wouldn't you be using the administration of flu vaccine and the charge for the actual medicine.

    Just my thought
    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"

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