We also have the same issue at our Urgent Care. If you coded a 99201 (new patient, nursing visit) then they would fall under established. Otherwise, suture removal or vaccine only would still allow you to code them as a new E & M level. Yes, if they have not been to you facility for 3 years then you could charge a new E & M also. Our system has a way that we can verify the date of their last visit. The check in girls are in charge of watching this to see when the last visit occured but it is a little more time consuming and then the nurses verify by review the previous notes prior to the Doctor entering the room. We still miss some on occassion but it is better than missing them all.
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