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Billing a New preventive visit with a new or established office visit

  1. #1
    Exclamation Billing a New preventive visit with a new or established office visit
    Medical Coding Books
    I have a question concerning billing a new patient 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 I should bill the preventive as new and the E/M as established even though they happen 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
    No, that is not correct. I have dealt with this issue many times. A new patient is a new patient. Check the CPT narrative for Preventive Medicine Services. If a patient comes in for a well check and an abnormality is found or if for instance the patient complains of burning with urination and the Dr. does an assessment and treats the patient for a UTI, then the appropriate level of E&M should be charged (99201-99205) and you will need to append modifier 25 along with billing for the new patient Preventive Med E&M code 99381-99387. You may not get paid though, the payor may still bundle them together.



  3. #3
    Overland Park, KS
    Check out CPT Assistant, October 2006. I think it will provide you the guidance you need here.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

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