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New Patient Physical & New Patient Acute same DOS

  1. #1
    Question New Patient Physical & New Patient Acute same DOS
    Medical Coding Books
    Hello there,

    I recently took an auditing class and was told that when a patient comes in for a routine physical, and is a new patient, also complains of an acute issue (which is treated/additional work is done), that you cannot bill both a new patient CPE code (99381-99387) and a new patient E/M code (99201-99205) as the history components would overlap each other, a physical requires a complete PFSH & the new patient E/M codes must meet or exceed all 3 components.

    If you think about it, this makes sense, however per CPT under Preventive Medicine Srvcs it states: If a problem/abnormality is encountered & is significant enough to require additional work, report codes 99201-99215.

    If it is inappropriate to report these two codes together as new, then why does CPT show the use of the new codes?

    I was wondering if anyone knows of a website or some place I could find additional info on the issue?

    From past billings, we have received denials for Medicaid patients, but seems most commercial insurances will pay both as new.

    Any info on this would be greatly appreciated. Thanks

  2. #2
    Sorry, don't have ready material to post, but we have been coding these together for some months now and don't have any billing issues per client.
    Girish Dadhich, CPC

  3. #3
    Lauderdale Lakes
    Last edited by tpontillo; 06-16-2011 at 07:18 AM.

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