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Thread: Billing a New Preventive Visit with a New Office Visit

  1. #1

    Exclamation Billing a New Preventive Visit with a New Office Visit

    AAPC: Back to School
    I have a question concerning billing a new pt preventive visit with a new pt E/M at the same time. I was told that I could not bill these two together as new but should bill the preventive as new and the E/M as established even though they happened during the same encounter. I have researched through the CPT book and cannot find evidence that this would be true. Can anyone help?

  2. #2
    Join Date
    Apr 2007
    Engelwood, CO


    Both E&M services are coded as a NP on that initial encounter. At least that's what an earlier AAPC Forum post recommended. Forum quote follows...

    Becky, CPC

    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

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