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necessary to bill a new patient

  1. #1
    Default necessary to bill a new patient
    Medical Coding Books
    Without thought to revenue, is it possible for a provider to ONLY use established patient E/Ms (99211-99215)? I know this seems different, but I have a provider (within a large group) that does not want to bill using new patient codes.

    All the research I have done gives direction on when NOT to use new patient codes. My question is, are payors ok with only billing established? especially Medicare? I can not find anything definitive that says we MUST bill new codes for new patients. Any help would be appreciated.

    Thank you
    Melissa Tescher, CPC, CPMA, CEMC Compliance and Coding Specialist
    Willamette Valley Professional Services member National Advisory Board 2013-2015

  2. #2
    Default
    Never heard anything like this. Why whould not your provider want to get higher reimbursement?

  3. Default
    I wonder if this is because only 2 of the 3 categories is required for established codes. No matter the reason, it is wrong. I have had providers complain that they have to 'figure out' who is new/established. They want the EMR to figure it out for them. After a few low audit scores they usually come around.
    Dee
    CPC, CPCO, CPMA, CPCD

  4. #4
    Default
    Quote Originally Posted by DeeCPC View Post
    I wonder if this is because only 2 of the 3 categories is required for established codes. No matter the reason, it is wrong. I have had providers complain that they have to 'figure out' who is new/established. They want the EMR to figure it out for them. After a few low audit scores they usually come around.
    How could the provider not know if the patient they are seeing is new/established? Sounds like there needs to be some type of protocol set in place for these providers to know what the pt's status is?

    Just my thoughts. What EMR are they using?
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  5. Default
    In the EMR all previous visits with all departments (including nurse visits, emails and phone calls) are listed. There is a filter that can be used to weed out all other departments so only a specific department is seen. Then the providers have to switch from the EMR section to the billing section to write a note and code the visit.
    Since it is a computer program, I can understand when they wonder why the system can't prompt the status for them. Eitherway, I mark it wrong in their audit every time since they have been taught how to verify the status.
    Dee
    CPC, CPCO, CPMA, CPCD

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