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Ped patients w/congenital anomalies

  1. #1
    Default Ped patients w/congenital anomalies
    Medical Coding Books
    I have a patient that has not been seen since 11/2007 and now came in for a check-up I corrected the code from a 99213 to a 99203. The provider does not agree with me, he state that a pediatric patient with congenital anomalies are established patients who may be seen at 1-5 year intervals as part of their regular follow-up, has anyone heard of this?

  2. #2
    Milwaukee WI
    Default I have the same problem
    I have had the same discussion with my plastic surgeons who follow pediatric patients for many years after their initial surgery.

    The CPT rules are clear, however. A patient who has not been seen for more than 3 years, is considered a new patient. The reason for this is that a long interval between visits will require more work on the part of the physician to complete a history and work-up the patient.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Smile Thank you
    Your answer was very helpful. Thank you again

  4. #4
    Los Alamitos CA
    if you are changing 99213 to new patient the highest level you can get is 99202 for a new patient.

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