I have a question concerning an E/M and an Preventive visit billed at the same time for a new pt. I was told that I had to bill the E/M visit as an established even though the pt was new and we billed the Preventive as new. I feel that being the pt was new and so were the extra problems that they should both be listed as new. I could not find anything in the CPC or the ACOG that would help. Any Ideas?
You bill both out as NP. I know I have backup to that somewhere. I'll pass along the article if I can find it.
I knew I had seen it somewhere. I found an earlier post right here on the AAPC forum in another category:
02-09-2009, 03:29 PM
The question as to how to code a new patient receiving both a preventive service and a problem-based E/M at the initial encounter was asked of the AMA. They responded, in the October 2006 CPT Assistant:
"...if a preventive medicine service and an office or other outpatient service are each provided during the same patient encounter, then it is appropriate to report both E/M services as new patient codes (ie, 99381-99387 and 99201-99205, as appropriate), provided the patient meets the requirements of a new patient based upon the previously noted guidelines.
If, however, the acute visit (ie, office or other outpatient service, 99201-99215) is performed on a date subsequent to the new patient preventive medicine service and within 3 years, then it would be appropriate to report the established office or other outpatient visit code (ie, 99211-99215, as appropriate)."
This is based on the logic that the new vs. established decision is made each time a patient "presents" to the office. They may receive multiple services during the initial "presentation," but if they were provided back-to-back during this initial "presentation," we do not change the label after the first service. The label assigned when they walk in stays with this patient until they leave the office. -----------------Seth Canterbury, CPC, ACS-EM